NUR 421 Exam 4 Review Guide.docx - 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

NUR 421 Exam 4 Review Guide.docx - EXAM 4 Modules 11-13(Ch...

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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 findings Lump or thickening in BR or mammo abnormality Most oft in upper outer quadrant of BR (location of most of glandular tiss) Characteristically hard & maybe irregularly shaped, poorly delineated, nonmobile, nontender SOMETIMES - nipple discharge: usu unilateral, can be clear or bloody Nipple retraction & peau d’orange can occur Large CA: infiltration, induration, dimpling of overlying skin can occur Table 51-9 General : axillary & supraclavicular lymphadenopathy Skin : 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 BX Complications = 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), BX Care of a patient after a mastectomy Restore arm function on affected side: post-op arm & shoulder exercises (start gradually) - prevent contractures & muscle shortening, maintain muscle tone, improve lymph and blood circulation Goal of exercise is gradual return to full ROM Control post-op pain: admin analgesics when in pain; 30 min before exercises Upper extremity lymphedema: measures to prevent & reduce - no BP, venipuncture, injections on affected arm Affected arm should not be in dependent position for long Prevent infection, burns, compromised circulation to affected side Decongestive therapy = massage-like to reduce lymphedema Compression sleeve to reduce fluid during day and when flying Advise 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 Cancer Cervical Cancer prevention Hispanic women most likely to get cervical CA DX; African-Am women have highest mortality rate Risks: infect w high risk strains HPV (16 & 18), immunosuppressed, low SES, chlamydia infection, smoking
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