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EXAM 4: Modules 11-13 (Ch. 26, 27, 41, 51, 53, 54, 58, 60)Breast Cancer: (Risks = female, >50, hormone use [esp. post-menopausal HRT], family HX, personal HX of CA [BR, colon, endometrial, ovarian], early menarche (< 12), late menopause (>55), no pregnancy or > 30 y.o., B9 BR disease [w atypical epithelial hyperplasia, lobular carcinoma in situ], wt gain & obesity post menopause, xp to ionizing radiation)Assessment findingsLump or thickening in BR or mammo abnormalityMost oft in upper outer quadrant of BR (location of most of glandular tiss)Characteristically hard & maybe irregularly shaped, poorly delineated, nonmobile, nontenderSOMETIMES - nipple discharge: usu unilateral, can be clear or bloodyNipple retraction & peau d’orange can occurLarge CA: infiltration, induration, dimpling of overlying skin can occurTable 51-9General: axillary & supraclavicular lymphadenopathySkin: hard, irreg, nonmobile BR lump most oft in upper outer sector, poss fixed to fascia or chest wall; thickening of breast; nipple inversion or retraction, erosion; edema (peau d’orange), erythema, induration, infiltration, or dimpling (later stages); firm, discrete nodules @ mastectomy site (poss indic of local recur); periph edema (poss indic of metastasis)Respiratory: pleural effusions (poss indic of metastasis)GI: hepatomegaly, jaundice, ascities (poss indic of liver metastasis)Poss DX findings: mass or change in tiss on BR exam; abnorm mammo; US; BR MRI; + FNA, surgical BX or oth sim results w needle BXComplications = recurrence: locally = skin, chest wall; regional = lymph nodes; distant = skeletal, spinal cord, brain, lungs (nodules & pleural effusions), liver,bone marrow -> metastases primarily thru lymphatics (usu thru axilla)Breast cancer screening: radiologic & BX to DX (risk/recurrence test = axillary lymph node analysis, tumor size, estrogen & progesterone receptor status, cell-proliferative indices, genomic assays) DX w: mammo, US (if indicated), BR MRI (if indicated), BXCare of a patient after a mastectomyRestore arm function on affected side: post-op arm & shoulder exercises (start gradually) - prevent contractures & muscle shortening, maintain muscle tone, improve lymph and blood circulationGoal of exercise is gradual return to full ROMControl post-op pain: admin analgesics when in pain; 30 min before exercisesUpper extremity lymphedema: measures to prevent & reduce - no BP, venipuncture, injections on affected armAffected arm should not be in dependent position for longPrevent infection, burns, compromised circulation to affected sideDecongestive therapy = massage-like to reduce lymphedemaCompression sleeve to reduce fluid during day and when flyingAdvise to report fever, inflamm @ surg site, erythema, post-op constipation, unusual swelling, new low back pain, weakness, SOB, change in mental status (including confusion)Female CancerCervical Cancer preventionHispanic women most likely to get cervical CA DX; African-Am women have highest mortality rateRisks: infect w high risk strains HPV (16 & 18), immunosuppressed, low SES, chlamydia infection, smoking