Breast Cancer Surgical Care
The use of nursing process for patients to implement the overall physical and mental care, can improve treatment, prevent the occurrence of postoperative complications.
(A) the principal nursing diagnosis
1. Preoperative
(1) fear, anxiety: lack of awareness of illness caused by fear of surgery; understanding of his illness are a result of organ damage, disfigurement caused.
(2), nutritional disorders, lower than body requirement: Since the decrease of food intake caused by loss of appetite; cancer consumption; because of the dominant sympathetic nervous excitement, inhibit the digestive tract movement and secretion of digestive gland, caused by loss of appetite.
(3) The change in comfort, pain: caused by neural invasion of tumors.
2. Surgery
(1) changes in vital signs may be: with the anesthesia and surgery.
(2) a comfortable change, incision pain, physical discomfort operated side: from surgery caused.
(3) the possibility of operative side limb edema: Due to surgery, axillary lymph node dissection to lymph and venous blood due to poor return.
(4), skin integrity damage: caused due to surgery.
(5) Rehabilitation lack of knowledge: Because not receive special education and limited literacy cause.
(B) nursing care
1. Preoperative
(1) to provide a wide range of life care.
â‘ instructs the patient eating highly nutritious, digestible food, attention to food, color, smell, taste, increase the patient’s appetite, to meet the body’s nutritional needs, and reserves of energy to achieve tolerance of surgical purposes.
â‘¡ to develop good bowel habits, maintaining smooth stool, constipation, laxatives, when prescribed by a doctor to give.
(2) preoperative preparations.
â‘ perfect the relevant inspection.
â‘¡ skillful venipuncture operations, protecting the vein to alleviate the suffering of patients. Should not be OK because of postoperative ipsilateral limb venous puncture.
â‘¢ good skin preparation of operating area, especially in the armpit Department, should first be cleaned with soap and water after skin cut with sterile scissors flat armpit hair, then rushed in talcum powder, taut skin, using skin preparation knife shaving the net, to avoid skin damage. Those who need to skin graft, but also good for the skin area prepared.
(3) to strengthen health missionary, providing psychological support.
As patients and their families are worried about results of operations, coupled with the economic burden too heavy to show anxiety, frustration and responsibilities of nurses to care, patient and considerate, understanding the patient’s psychological state, listening attentively to the patient’s complain and to give help in understanding the disease were want to introduce the progress of treatment and survival rate of breast cancer information and related diseases and surgical knowledge, enhance the confidence of the patient’s treatment; right pain and the responsibility of nurses to have more contact with patients, to establish a good nurse-patient relationship, providing quiet and comfortable environment, with the appropriate use of medical sedation pain medications, improving the patient bad mood, to ensure rest and sleep, so that the body is in the best condition for surgery.
2. Surgery
(1) close observation of patient’s condition. Patients in continuous epidural anesthesia and surgical procedure is performed under intravenous anesthesia, surgery, after completion of the wards should be given back to supine, close monitoring of blood pressure, pulse and breathing. The patient awake and vital signs were given after the semi-recumbent position to facilitate breathing and drainage, to avoid or reduce the operative side limb edema. Observation of the wound dressing is dry. Early topical negative pressure dressing to attract or chest strap, sandbags pressure to help the skin graft attachment to avoid the accumulation of subcutaneous blood effusions. Note that suction drainage is smooth and intraoperative blood supply-side extremities.
(2) to prevent surgery limbs edema and dysfunction. In the operative side up to avoid limb venous puncture, and the appropriate elevation. After 3 days began to help the patient’s upper limb, first began to extend to the shoulder the elbow. Training methods for their own meals, hair, face and fingers climbing walls activities to promote limb blood circulation.
(3) strengthening of psychological care. As the breast cancer patient’s body after the impact the United States, so most of the patients is extremely low mood, showing irritability, low self-esteem, and even a lack of confidence in treatment. Nurses In addition to communication with patients should take the initiative and get the patient’s full confidence, we must also as far as possible they are most receptive to the implementation of the approach, diligence inspections, multi-conversation, introducing the necessity and importance of treatment, missionary chemotherapy and radiation side effects and its complications prevention.
(4) assisted living care. Patients bed rest period, the decline in self-care ability and responsibility of nurses according to Orem’s self-care model should be given to fully help, some assistance to support nursing education in different ways to meet their self-care needs.
(5) diet care. After the patient’s diet is important, in addition to the need to increase the heat, it should also increase the protein, vitamins and inorganic salts, in order to promote tissue growth and wound healing.
(6) The discharge guidance. Discharge guidance is an important part of holistic nursing care, to help patients understand and prevent disease, promote and restore health to play a role. In the care and treatment, the patient recovered missionary knowledge, including a balanced diet, surgery side limb functional training. Timely referral, regular chemotherapy and radiotherapy, the treatment and care programs recorded in the hospital medical records, the will urge family members pay close attention to changes in the patient’s psychological condition.
