breast and Reproductive system
RISK FACTOS PROCEDURES
• Breast Implants • Abortion
what is the problem with african american woman developing breast cancer
Their tumors are more aggressive, difficult to treat effectively, and usually larger and more advanced at the time of diagnosis (NCI, 2013a).
Toxic Shock Syndrome Causes:
#1 Tampon use, GYN surgeries, internal contraceptives, surgical wound infection not washing hands • Menstrual blood allows growth of Staphylococcus aureus
The three primary roles of the female reproductive system are:
(1) production of ova (2) secretion of hormones, and (3)production and facilitation of the development of a fetus during pregnancy
The stage of a cancer
(on a scale of 1 to 4, with 4 being the most advanced) describes how advanced the disease is and helps determine the course of treatment. Many breast cancers today are detected at stage 1 or 2. In situ cancer, usually DCIS, is called Stage 0. There are several different staging systems in use.
Fibrocystic Breast Condition management
-Breast ultrasound -Fine needle aspiration -drains cyst and reduces pressure and pain -Needle biopsy -if suspicious findings on mammogram or cyst unchanged
Reproductive Cancer - Females treatment
-Chemotherapy -Local ablation • Excisional removal or hysterectomy or oophorectomy, salpingectomy -Radiation: external beam or brachytherapy -Radical surgery -Debulked if too large for removal
Dysfunctional Uterine Bleeding treatment
-Complete menstrual history -CBC to see if anemic -Hormone manipulation #1 -Hysterectomy (last) -Inspect external genitalia and a pelvic exam -Thyroid and reproductive hormone levels Surgery: endometrial ablation (middle scrap out help bleeding)
Dysfunctional Uterine Bleeding
-Excessive frequent bleeding more than every 21 days • Usually at the beginning or end of the reproductive years
Uterine Prolapse signs/symptoms
-Heavy sensation in pelvis,, -urinary problems (incontinence or retention) -backache -vagina, "something falling out" -painful intercourse, pressure -Problem exaggerated with coughing, lifting heavy objects or standing for a long period of time
preoperative surgery
-Large tumor may be treated with chemotherapy (neo adjuvant therapy) to shrink -Axillary lump node dissection or Sentinel lymph node biopsy -Sedimentation Rate - Serum Alkaline Phosphatase -Calcium
Prostatectomy postoperative maintain?? monitor? and look for s/s of what? relief what what? what is given to prevent straining ?
-Maintain fluid balance: monitor I and O, electrolytes, nature of urine output, foley to gravity, IV fluid replacement as ordered -Monitor vital signs, dressing and s/s postop complications and hazards of immobility -Relief of pain: Ditropan (Oxybutynin) to relax smooth muscle for bladder spasm, warm compresses, sitz baths -Stool softeners to prevent straining
To facilitate effective communication with patients on sexuality and sexual health, providers should: -what can facilitate a discussion on sexuality and sexual health? -Assure patients that information provided is bound by? -Some providers may feel that their patients' sexual lives are too personal to ask about, and patients may assume that their providers will tell them what they need to know. Using what type of listening can continue to establish trust between the nurse and patient allows the patient to openly express feelings or concerns ? -Developing trust with patients by using what is key?
-Taking a sexual history -HIPPA guidelines -nonjudgmental listening -a professional demeanor
Mammography
-X-ray of the breast Has been shown to save lives in patients 50-69 -Data mixed on usefulness for patients 40-49 -Normal mammogram does not rule out possibility of cancer completely
Pelvic exam speculum
-tool used to hold the walls of vagina open so physician can see the tissue inside -should not be painful
how to detect any changes in breast contour
Then with hands on waist as the patient pushes in the pectoralis muscles contract
When determining when to begin screening, individuals should discuss what with their physicians to determine the best screening schedule for them.
their status and history
nursing diagnoses for masectomy
1. At riskforinfection,r/t surgical incision 2. Ineffectivetissue perfusion, r/t edema 3. Acute pain, r/t surgical intervention 4. Disturbedbodyimage,r/t surgical removal of breast 5.Decisionalconflictabout treatment, r/t concerns about risks and benefits 6. Interrupted family processes, r/t effect of surgery 7. Fear, r/t disease process/prognosis
Each breast contains how many cone shaped lobes and what is it made up of?
12-20 which are made up of glandular elements (lobules and ducts) and are separated by fat and fibrous tissue, blood and lymph vessels all binding the lobes together.
women EFFECTS OF AGING ON REPRODUCTIVE SYSTEMS Altered? ________? reduction of? breast? vaginal walls? hair? _________? atrophy of?
estrogen production Atherosclerosis Bone mass fibrosis Drying, smoothing, and thinning Graying, thinning Menopause Organ/tissue
vulvovaginitis teaching Prevention: type of clothes not to wear? wipe vagina how? Avoid what else? Avoid and ask if?
avoid synthetic tight clothes, teach wiping front to back, no douching and scratching sex partners, chemicals, feminine hygiene products unprotected sex bubble bath, antibiotic use, diabetes Improved health hygiene and practices
Assessing the patient's what may be in order.
body weight, height, and body mass index
risk Factors for Breast Cancer Hormones:
estrogens in Hormone replacement therapy & Birth control pills
The American Cancer Society advises all women to begin having annual PAP smears at what age?
21 years of age Between the ages of 21-29 women should have a PAP smear every 3 years Women between ages 30-65 should have a PAP smear and HPV testing every 5 years Follow up care
conclusion • Disorders of the reproductive system include a wide variety of conditions affecting ______? Why the patient may experience anxiety and embarrassment?
both females and males. Because these disorders focus on the genitalia, and in some instances on sexuality,
The female reproductive system is located
both inside (internal) and outside (external) the body
The accuracy of the procedure FNA depends on
experience of the person performing the procedure.
female reproductive system internal genitalia
fallopian tubes, ovaries, vagina, uterus corpus, cervix, Breasts Menstruation and menopause
Intraductal ectasia / papilloma
40-55 years old, rarely palpable • Epithelial lining of duct forms outgrowth of tissue on a stem or pedunculated outgrowth • Trauma and erosion in duct
proscar (finasteride)
5 alpha reductase inhibitor shrinks prostate and wear gloves can leak in skin
prognosis after Breast Cancer
5-Year Survival (%) 10 year survival Stage 0 95 90 Stage I 85 70 Stage II 70 50 Stage III 55 30 Stage IV 5 2
palpation: Developmental differences: Adolescent breast tissue: During pregnancy and lactation:
: Adolescent breast tissue: firm and lobular During pregnancy and lactation: firmer, larger, lobules more distinct
Hysterosalpingography:
: is an x-ray that uses injection of contrast medium to visualize cervix, uterus, and fallopian tubes
Benign Prostatic Hypertrophy complications
: orthostatic hypotension, tachycardia, syncope( Flomax) Proscar (anti-androgen) se: gynecomastia
During a Clinical Breast Exam, the examiner observes a discharge from the nipple What is most important to include in the documentation of this finding? A) Area of "the clock" that was compressed when the discharge was released B) Amount of pressure required for the discharge to be released C) Frequency and technique the patient uses for BSE D) History of difficulty or pain when attempting to breast-feed
A
the patient is lying in bed after a mastectomy. How does the nurse position the patient? a) Head of bed up at least 30 degrees with the affected arm elevated on a pillow. b) Supine body position with the affected arm positioned straight by the side. c) Any position that is most comfortable to the patient. d) Side-lying position with the unaffected side down towards mattress.
A
BRCA1 and BRCA2 genes are associated with
familial breast and ovarian cancers and are implicated in the majority of hereditary breast cancer in the United States and Europe.
Breast Physical Assessment: Inspection
A lump or thickening that feels different from the rest of the breast a change in skin texture such as dimpling a rash or redness on the skin or around the nipple your nipple becomes inverted puffed in or changes shape discharge (liquid) from your nipple swelling in your armpit or around your collar bone
One to two years before the onset of the first menstrual period( menarche) breasts begin to grow under the influence of the
female hormones estrogen and progesterone
The breast has a rich
lymphatic network that drains into axillary and clavicular channels.
Lymph nodes are part of the immune system and linked by
tiny vessels within the entire lymphatic system.
Oral contraceptives:
to suppress hormones
lymph Node Assessment and Removal *Sentinel (SLNB)*
AKA: sentinel lymph node dissection This newer procedure offers a less traumatic alternative for determining whether the cancer has spread beyond the breast. The SLNB procedure focuses on finding the specific lymph nodes (sentinel nodes) that are first to receive drainage from the breast tumor. SLNB is most appropriate for women with early-stage breast cancer with clinically negative axillary nodes
Danocrine:
to suppress ovarian function and estrogen stimulation of breast tissue
Reproductive Cancer teaching ovarian and cervical Can pt drive? can pt have sex? can pt lift? what can they do for pain? what happens with sutures? Lastly teach
No driving for 2 weeks Avoid intercourse for 6 weeks or until surgeon examines at follow up Avoid lifting anything heavier than 5 pounds Moist heat to abdomen for pain or hot bath Sutures are absorbable s/s of infection, fever, foul smelling discharge, persistent pain During radiation-repo
QUESTION 2 When assessing an aging adult man, what does the nurse note as a normal finding? * A. Decreased penis size B. Decreased pubic hair C. Decreased scrotal color D. Unilateral breast enlargement
ANSWER A: A decrease in size of penis is a normal finding in an older man. Rationale: Loss of pubic hair is not normal, nor is any enlargement of the breasts. The normally darker color of the scrotum does not change with aging.
QUESTION 3 When assessing an aging adult woman, what does the nurse note as a normal finding ? * Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A. Rectocele B. Larger breasts C. Vaginal dryness D. Severe osteoporosis
ANSWER C: Vaginal dryness occurs with decreased estrogen and increased androgens circulating in the aging female. Rationale: Vaginal dryness occurs with decreased estrogen and increased androgens circulating in the aging female. This also leads to breast and genital atrophy, reduction in bone mass, and increase in atherosclerosis. A rectocele may occur and cause sexual or fecal elimination problems for the patient that will need treatment.
risk Factors for Breast Cancer Age and relative
Age: increases as a woman gets older. Relative:(mother or sister) #1 cause heredity/personal history first generation siblings
Chemotherapy Inform patient about side effects
Alopecia Nausea Vomiting Mucositis Bone marrow suppression/Myelosuppression Peripheral neuropathy Fatigue, SOB Chronic cough , Edema, infertility cardiotoxic effects • Cognitive impairment - or "chemo brain"—the forgetfulness, loss of concentration, and decrease in mental functioning that often
groups have the lowest incidence of the disease.
American Indian/Alaska Natives and women of Asian and Pacific Islander Hispanic women have a much lower incidence of breast cancer than either black or white women (NCI, 2013a).
rectal exam and performed by who?
An advanced nurse practitioner or physician will continue the exam to include palpation of the inguinal areas for presence of hernia or lymph node enlargement and possibly to detect prostate enlargemen
tail of Spence
An area of breast tissue, extends into the axilla.
Structural Disorders - Male Spermatocele treatment
No treatment needed if not bothering patient If enlarges with discomfort, surgical removal or drained may be warranted
risk Factors for Breast Cancer History of cancer:
Radiation Exposure History of cancer: breast, uterus, cervix, ovary
lymphedema management *NO:*
• BP forever • Blood draws forever in arm • Cuts, injuries to prevent infection • Compression sleeve or glove • Avoid constricting garments • Vaccinations • Extreme increases in temperature
invasive Breast Cancer Disease Process
As a malignant tumor grows, it may spread locally, invading and sometimes destroying other tissues, or cells may break away from the tumor and get into the lymphatic vessels, or into the blood vessels, and travel to distant parts of the body.
who has the best survival rates with breast cancer The reasons for these disparities are not clearly understood, but socioeconomics, genetics, environmental exposure, and limited access to healthcare likely all contribute.
Asian Americans, especially Japanese Americans and Chinese Americans
postoperative care plan Dressing:
Assess bleeding & JP drainage flow, amount, color Monitor amount and color drainage
libido (sex drive, sperm production, and the ability to have or sustain an erection can be affected by what substances
Assess for alcohol, tobacco, and drug use (prescribed, OTC and illicit drugs)
reproductive cancer ovarian and cervical females post op
Assess vital signs and pain, manage drains and catheters, assess urine and blood, dressing embolism stockings, incentive spirometry, ambulation,
stem cell transplantation
Autologous or allogeneic stem cell transplantation from bone marrow is an option for patients at high risk for recurrence or with advanced disease Option for women with strong risk for recurrence or with advanced disease Autologous takes cell from patient's bone marrow Allogeneic uses a healthy donor as rescue therapy after after very high doses of chemotherapy
health maintenance during chemotherapy what to avoid? practice? vilgilant for s/s of? what type of care needed? nutrition?
Avoiding infection and crowds Hand washing • Vigilant for s/s infection:check temperature every day at same time, CVAD site, mouth sores, sore throat • Denture care every meal, mouth rinses • :proteinand fluids/avoid alcohol
chemotherapy treatment affects what?
both normal cells and cancer cells, but because cancer cells generally divide more rapidly, and are less effective at self-repair, they are more affected by the therapy than normal cells. As a result, more cancer cells than normal cells are killed. With proper choice and timing of chemotherapy, the tumor can be destroyed without excessive damage to normal tissues.
It is the second major cause of death by cancer of women in the United States.
breast cancer
Gynecomastia
breast enlargement in men; obesity, • Abnormal growth glandular tissue
Teach a patient and assess patient's ability to perform
breast self exam. Opportunity for woman to become familiar with her breasts
salpingitis (uterine tube infection) is often caused
by chlamydia and can result in female infertility.
how is the inflamed appearance with IBC caused?
by invasion of cancer cells into the subdermal lymphatic channels. If antibiotics do not rapidly change the appearance, biopsy should be performed.
postoperative care plan Avoid using affected arm for
BP readings Injections Blood draws
In fact, up to 1% of Ashkenazi Jewish women were found to have
BRCA1 gene mutation.
genetic risk: breast Cancer Susceptibility Gene
BRCA1&BRCA2 gene mutations • Normally these are tumor suppressors which establish stability of cells genetic information by helping repair proteins that regulate cell growth • Ashkenazi Jewishheritage increased incidence of getting gene
Uterine Fibroids
Benign slow solid tumor growth (growing tumor can cause pain) Disrupts pregnancy, trouble conceiving. and causes heavy excessive non menstrual bleeding not cancer
other studies
Biopsy § Cervical § Endometrial (and aspiration) § Breast biopsy and aspiration of breast fluid or tissue § Prostate
hormal therapy: Selected Estrogen Response Modifiers
Block effects of estrogen in Estrogen Receptor positive women Tamoxifen taken for 5 years for risk reduction Side effects:
done only if laboratory tests suggest the presence of bony metastases or if there are other known areas of metastases coupled with clinical presentation of bony pain.
Bone scans
dietary recommendations related to breast disease
Boost/ensure Echinacea- enhance immune system Vitamin C,E-antioxidant effects Low fat Soy=breast cancer risk St. Johns Wart-for depression Garlic extract-B/P
the most common cancer among women in the United States and the second most common cause of cancer death in women ages
Breast cancer 40-55
Local Recurrence
Breast cancer most commonly recurs locally—in or near the site of the original tumor, for example in or around the scar mastectomy is the preferred treatment
In the clinical breast exam what is palpated?
Breast tissue, nipples, and axillae for lumps, abnormalities, and enlarged lymph nodes.
The nurse is teaching a young patient about BSE. Which statement by the patient indicates a need for further instruction? A) " I should perform BSE on a monthly basis from now on." B) " I see my health care provider annually, but I should perform BSE." C) " BSE is a self-care measure that I can use to prevent breast cancer." D) " The best time to perform BSE is 1 week after my menstrual period."
C
Patients should be encouraged to focus on wellness—taking good care of body, mind, and spirit—by ?
eating a healthy diet, getting enough sleep and exercise, paying attention to symptoms, and getting regular checkups.
QUESTION 1 Which patient response during a genital-reproductive history requires further exploration by the nurse? * "I have had one pregnancy and one child." "I began my menses at age 14." "I would rather not answer questions about my sex life with my husband." "My breasts hurt in the beginning of my menstrual cycle."
C: "I would rather not answer questions about my sex life with my husband." Rationale: All of these questions could prompt further exploration by the nurse, but the patient's reluctance to discuss her sexual relationship may suggest abuse or unsafe circumstances for the woman in her relationship
3 way cath monitor
CBC Hand H VS and blood urine normal
second primary cancer
Cancer in different part of breast or in contralateral (opposite) breast may be a new cancer, This cancer may be different cell type and may be treated successfully with surgery alone, depending on the stage and tumor type. The biopsy may or may not be able to determine whether the new tumor is recurrent disease or a second primary, but it will help determine the treatment.
Gynecomastia Management
Careful evaluation for breast cancer
Uterine Fibroids Pressure on the surrounding organs causes
Cause no symptoms or may be cause of vaginal bleeding backache, bloating urinary problems, menorrhagia (excessive bleeding and metorrhagia (irregular bleeding) constipation pain, pressure distort uterus Interfere with fertility
how chemotherapy works
Cells go through several steps in the process of cell division. these drugs interfere with various parts of this cycle, making it difficult for the cells to reproduce and for the tumor to grow. The faster the growth, the more opportunity the drug has to disrupt the cycle.
Women are considered at high risk of breast cancer
either a BRCA1 or BRCA2 mutation, a family history of breast cancer in either a first- or second-degree relative on either the maternal or paternal side, or due to other factors.
long term effects of radiation therapy
Chronic Lymphedema • Cardiovascular Secondary malignancies
The American Society for Clinical Oncology (ASCO) recommends that patients see their doctor immediately if any of the following symptoms occur and/or persist: These symptoms might not signal a recurrence of cancer, but they call for prompt evaluation.
Chronic bone pain or tenderness (persistent) Skin rashes, redness, or swelling (persistent) New lumps in the breasts or chest Changes in the breasts Chest pain and any shortness of breath (persistent) Abdominal pain (persistent) Changes in weight, especially weight loss when not intentional
cancer of the penis treatment
Circumcision at infancy Small lesions excisional biopsy and radiation Partial or total surgical removal of penis
Structural Disorders - Male Varicocele
Cluster of dilated (swollen) veins caused by increased fluid due to damaged or incompetent valves • Usually symptomatic • Scrotal temperature may be affected causing infertility (a lot of warmth)
when Cure Is No Longer Possible
Collaborative Care • Social work/Counseling/Psychotherapy/Peer support groups • Chaplains/Family • Healthcare/Hospice
Prostate Cancer and whose at risk?
Commonslowgrowing type of male cancer • Risk increases beyond 65 y/o • Risk: high animal fat diet, low fiber, vasectomy, toxins, age, smoking obesity
Reproductive Cancer - Male Testicular Cancer s/s
Complaints of heavy sensation, discomfort in abdomen and swelling scrotum Higher risk in males with undescended testicles or with HIV
what surrounds the lobules and ducts?
Connective and fatty tissue including blood and lymph vessels
a atient has recently been diagnosed with breast cancer. Which is the most likely priority preoperative nursing care for this patient? A) Providing patient education B) Assisting the patient to make independent decisions C) Providing reassurance D) Providing a safe environment so the patient can talk openly about his /her feelings
D
which intervention is priority in the nursing care plan for a patient after a modified radical mastectomy? A) B) C) D) Position the patient on the affected side to aid with gravity flow of drainage from the incision site. Immobilize the arm on the affected side for the first 24 hours postoperatively. Assess the patient for anxiety because it can impede the healing process. Teach the patient signs and symptoms of infection and how to monitor for altered wound healing.
D
The human papilloma (HPV) test
can identify many high risk HPV infections associated with cervical cancer.
venous pattern
can signal increased blood supply required by a tumor
BPH Goal: normal urinary elimination pattern nonsurgical
Drug therapy • Finasteride(Proscar) and Dutasteride (Avodart) inhibit androgen levels • Cardura(Doxazosin)& Flomax (Tamsolosin) relax smooth muscles in prostate to improve urinary flow • SawPalmettoherb
what can cause a discharge to become worse?
Drugs like antibiotics or tight clothing may cause a discharge to become worse
Dysfunctional Uterine Bleeding cause
Due to a hormonal imbalance-ovaries fail to ovulate estrogen and progesterone off
endometriosis s/s
Dysmenorrhea, dyspareunia, Depression relationship strain absence from work infertility pelvic discomfort or pain, pain with bowel movements radiating to back or leg Very painful menstruation prior or during leads to infertility
normal CA level
cells found in epithelial lining. level normal if below 35 and high is bad which could mean cancer
Cystocele causes
Damage or by the strain or an injury during childbirth to anterior vaginal support structures Also seen in elderly women when genital atrophy teach kegels
NORMAL PHYSICAL ASSESSMENT OF REPRODUCTIVE SYSTEM male of External genitalia:
Diamond shaped hair distribution, no penile lesions or discharge, symmetric scrotum, no masses, descended testicles, no hernia
risk factors DIET
Diet AND Dietary supplements: soy Weight AND Exercise Alcohol consumption AND Smoking
Prostate Cancer s/s
Difficulty starting stream infections, retention hematuria, nocturia, pain with intercourse weight loss stony hard node not normal • PSAlevel>2.5ng/mL
invasive breast cancer
Distant metastases are of most concern, because they can damage vital organs. • This advanced stage of breast cancer, called metastatic cancer, is less common and its management is more difficult.
RISK FACTORS OUTSIDE
Environmental exposure: • Fertilizers • Pesticides
The nurse should be aware of and sensitive to differences in sexual orientation and sexual practices. what is the first step in obtaining a patient history.
Establishing a trusting relationship
gene expression
Estrogen receptors (ER Positive) Progesterone Receptors (PR Positive) HER2
PHYSICAL ASSESSMENT TECHNIQUES MALE
Examination of external genitalia Assess for inguinal hernia .
What should be included in a male exam?
Examination of male breast and axilla The nipple and areola are inspected for masses and nipple discharge
also known as a lumpectomy or wide local excision, is performed by a surgeon and removes an entire lump or mass plus a small margin of the surrounding normal tissue. It is the most common type of surgical biopsy. Biopsy tissue may be sent as "fresh," meaning it is not placed in a preservative solution and is intended for immediate examination by the pathologist. It must be moved quickly to its intended destination to avoid deterioration. A specimen may also be sent for examination in preservative solution. In this case, it need not be transported with the same sense of urgency.
Excisional biopsy,
Aromatase Inhibitors
Faslodex (Fulvestrant) Acts on body fat sources of estrogen in post menopausal women Inhibits conversion of androgen to estrogen
pelvic examination how often for women?
Females should have yearly pelvic exams -when she starts having sexual intercourse -when she turns 18
uses a small hollow needle to aspirate fluid or cells from a palpable breast lump or mass. It is performed without anesthesia, sometimes in a physician's office.
Fine-needle aspiration (FNA) biopsy
If clear fluid can be aspirated from the lump, it is diagnosed as a benign cyst. However, if the fluid is bloody or if fluid cannot be aspirated, the cells in the needle are transferred to a slide and sent to the pathology laboratory for review.
Fine-needle aspiration (FNA) biopsy diagnosis
risk Factors for Breast Cancer gender and what are protective against breast cancer?
Gender: female (1% males) Pregnancy and breastfeeding
Ductal Ectasia cause
cellular debris is deposited in distended ducts causing an Inflammatory response behind areola /nipple-duct becomes blocked
other studies
HPV testing Urinalysis Imaging studies: § General x-rays § CT scans for reproductive system disorders § Hysterosalpingography—x-ray of cervix, uterus, and fallopian tubes § Mammography
A common complaint pts have
Heavy bleeding or lack of bleeding
INDICATORS OF INHERITED BREAST CANCER
History of breast cancer in maternal or paternal relatives Multiple cases of breast cancer in the same family Women diagnosed at a younger age (less than 50 years old) Ovarian cancer in the family Male breast cancer in the family Breast and ovarian cancer in the same woman Ashkenazi Jewish heritage Childbearing trends have changed over the past 40 years, with many women delaying childbirth until after age 30. However, the younger a woman is when her first childbirth occurs, the lower her breast cancer risk. early pregnancy and breastfeeding transforms the breast cells into their final mature phase. Breast cells that are fully mature may be less influenced by the effect of carcinogens (Hartmann & Loprinzi, 2012). Cumulative exposure to estrogen over a women's lifetime This exposure may be influenced from the cumulative history of her menstrual cycle. Both early onset of menarche (<12 years) and later age at menopause (>55 years) may increase her exposure to endogenous hormones, which may ultimately increase breast cell proliferation and the possibility of cancer growth promotion (ACS, 2012c).
Assessment of breast cancer
History of medical disorders, surgical history, family history of cancer, obstetrical and gynecologic history, present medications to include hormonal replacement therapy, fertility treatments, and social habits Psychosocial information such as marital status, occupation, available resources and support people is obtained Recent x-rays or diagnostic tests are noted Focused questions pertaining to breast disorders should inquire about the onset of the disorder and the length of time it has been present The patient should be asked if any masses are palpable and if there is any associated pain, redness, swelling, nipple discharge, or skin changes. Also assess the patient's knowledge and comfort in practicing breast self examination (BSE)
breast mass
History of: how, when, who discovered Helps determine length of time tumor present Previous biopsies? Time between discovery of lump and appointment for evaluation Specific complaints re: pain or mass Ask about body changes-spread of cancer? Joint/bone pain? "Face of clock" location of mass Mobile or fixed? Skin changes: dimpling, orange peel appearance Redness -warmth-nipple retraction- ulceration Nipple discharge? Bilateral involvement? Lymph node enlargement: supraclavicular or axillary Pain, soreness
asSESSMENT TECHNIQUES: FEMALE History:
History: pain, bleeding, discharge, masses Physical assessment:
BLOOD STUDIES
Hormone levels HIV testing Serologic testing Prostate-specific antigen (PSA) Cultures
accounts for about 80% of cases and is the most common form of breast cancer
Invasive ductal carcinoma which breaks through the wall of the duct into the breast tissue. It commonly forms a hard lump, which feels much firmer than fibroadenomas (benign breast lumps).
lymph Node Assessment and Removal *Axillary (ALND)*
Involves removal of a large number of axillary lymph nodes for examination by a pathologist. Formerly a part of all breast cancer surgeries, axillary dissection has been replaced in many cases by a newer procedure called sentinel lymph node biopsy.
Mammography:
Is an x-ray of breast soft tissue
strengthen and maintain the tone of the pubococcygeal muscle, which supports the ?
Kegel exercises pelvic organs, reduce stress incontinence and uterine prolapse
nipple
center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.
Aromatase Inhibitors s/s
Loss of bone density • Osteoporosis
what may be related to ovarian dysfunction
Low levels of body fat
Warning signs of breast cancer include: inside breast or underarm what forms? breast changes how? breast changes how? what happens to skin and nipple? what pulls in? what suddenly happens with nipple? what happens and doesn't go away?
Lump, hard knot, or thickening Swelling, warmth, redness, or darkening Change in the size or shape of the breast Dimpling or puckering of the skin Itchy, scaly sore or rash on the nipple Pulling in of the nipple or other parts of the breast Nipple discharge that starts suddenly New pain in one spot that does not go away
staging lymph nodes N lymph nodes
Lymph nodes are small oval structures that filter lymph as it flows through lymphatic vessels and on to the blood stream. These nodes act to filter out particulate matter, especially bacteria and cancer cells, from entering the blood stream. They may in time become the avenue through which cancer spreads to other parts of the body.
nuring management *potential complications of mastectomy
Lymphedema because lymph nodes regulate lymph gets rid of all impurities and filters it out. now removing all lymph nodes accumulate fluid
lymphedema *Initial goal:*
Maintain integrity of skin and underlying structures, reducing fluid volume • Massage and manual drainage • Compression sleeve with selected range of pressures while awake • Intermittent pneumatic compression devices
risk Factors for Breast Cancer Menstrual history and childbirth
Menstrual history: early onset-late menopause before 12 or late 50 Childbirth: first child after the age of 30 or having no children at all due to hormone changes they dont have
Staging Metastasis M- Metastasis
Metastasis (spread) of the cancer beyond the breast and underarm (axillary) nodes is classified as shown in the table below. Generally, the smaller the cancer, the less likely it is to have spread. The most common sites for breast cancer metastasis are the bone, brain, lungs, and liver.
who has the highest breast cancer mortality rate of any ethnic group in the United States?
Mortality Black women
Reproductive Cancer - Females cervical
Most caused by HPV Asymptomatic found with PAP smear Colposcopy to biopsy tissue if pap smear abnormal
goal is to pinpoint a mammographic finding, either microcalcifications or a small nonpalpable tumor that is to be excised. Using a mammography machine, the radiologist locates the area of concern and inserts a hollow needle into that area. A thin wire is inserted through the needle into the lesion. Then the needle may be withdrawn. These markings allow the pathologist to envision the specimen within the breast. This is especially crucial if additional breast tissue must be excised but a breast-conserving procedure is planned
Needle-localization biopsy
risk Factors for Breast Cancer Genetics :
certain conditions that are inherited > 70% have no risk factors
complemENTARY AND ALTERNATIVE MEDICINE (CAM)
Nutritional supplements Dietary changes Herbal supplements Exercise, yoga, tai chi Meditation/Relaxation ,Massage ,Acupuncture Guided imagery Prayer
risk Factors for Breast Cancer Diet:
Obesity Diet: High fat Lack of Physical Activity; Stress Alcohol: 3-14 drinks/week
Metastatic Disease (Distant Metastasis)
Once breast cancer has spread to distant organs (stage IV), cure is no longer possible. palliative measures:, including radiation, chemotherapy, hormone therapies, targeted therapies, and bisphonates, can significantly improve survival length and quality of life.
Fibroadenoma s/s
Oval, free, movable, rubbery lesions anywhere in breast 0.4 or 1 -6 inches in diameter
Structural Disorders of Reproductive System-Male Hydrocele
Painless cystic mass usually filled with straw-colored fluid formed around testis caused by impaired drainage of the scrotum
Breast cancer males Manifestations
Painless sub-areolar lump Nipple retraction Localized pain Nipple ulceration Bleeding/discharge
Palliative Care
Palliative care can be offered during this time. Palliative care specialists work together with the healthcare team, such as nurses, nutritionists, social workers, chaplains, pharmacists, and others, to focus on creating an individual plan to address any lasting treatment side effects, pain, emotional aspects, and other concerns of the cancer patient. The idea is to treat the whole person—including the physical, emotional, social, and spiritual aspects. Palliative care is often confused with hospice care, which is provided for people who have a terminal diagnosis. Palliative care can be provided at any time during a cancer diagnosis, not just at the end of life. The inclusion of palliative care may include positive benefits such as: The ability to fully complete treatment Improved quality of life during treatment Increased ability to perform daily activities Living longer Improved ability to deal with the emotions Increased connection to social support Fewer hospitalizations
What should be referred for evaluation?
Palpable masses
what usually completes pelvic exam?
Pap smear -cells scraped from cervix and examined under microscope to check for dieases or other problems
current health problems
Patient Concern Nursing Assessment Pain Type, intensity, location, duration, factors that relieve or worsen, relationship to sexual functions, medications Does pain interfere with rest? Bleeding Presence, absence, character, amount, timing, onset and duration, associated symptoms Discharge Amount and character, lesions, bleeding, itching, pain, presence of symptoms in partner Masses Location and characteristics, associated symptoms, relation to menstrual cycle
what can cause pelvic scarring or adhesions in the fallopian tubes.
Pelvic inflammatory disease or a ruptured appendix
female reproductive system External genitalia
clitoris, vulva, vestibule, labia majora, labia minora, mons pubis, perineum
if someone has cramping with 3 way cath do what
close out irritation use piston syrinhe and push in fluid and pull it out. you will see urine output again
have proved more effective in detecting soft tissue metastases than metastatic bone lesions.
Positron emission tomography (PET) scans
breast reconstruction For the majority of women with breast cancer, body-image change is a very important issue. Whether or not to have reconstructive surgery or use a breast prosthesis after a mastectomy is a highly personal decision.
Pre and Post Expander and Implant
if amenorrhea is reported what should be considered?
Pregnancy Postmenopausal bleeding must be investigated
Fibrocystic Breast Condition common in what women ? and why? Cyst enlargement is in response to ? and when do they resolve
Premenopausal women 20-30 years old due to hormonal imbalance of estrogen-progesterone monthly hormone changes and are painful-often resolved after period ends/or seen with HRT in menopausal women
Encourage expression of feelings
communicating their love for others, forgiveness, and/or gratitude)
Health maintenance practices
Previous clinical breast exam findings How often is screening done? Previous mammography results Previous breast biopsy results BSE practices Primary support person-who included in care, teaching, support Feelings regarding sexual dysfunction/sexuality/body image Stress management and coping strategies
what may be chosen for someone with breast cancer?
Prophylactic mastectomy, oophorectomy, and anti-estrogen chemo preventive drugs
Structural Disorders- Female Rectocele
Protrusion of rectum through a weakened vaginal wall
Reproductive Cancer - Male Testicular Cancer
Rare Testicular self examination to detect lump
Reproductive Cancer Male cancer of the penis
Rare squamous cell origin Foreskin and glans most common sites
rectocele cause
Rectocele and perineal lacerations during childbirth may affect the muscles and tissues of the pelvic floor teach kegels
postoperative care plan vital signs
Report temp >100.4 Every30minx2 Every 1hour x2 Every 4 hours
Data to obtain when assessing a patient with breast cancer:
Risk factors Breasts Mass Health Maintenance Practices
Lymphedema treatment
complete decongestive therapy manual lymph drainage, and compression, as prescribed by a PT, OT, or other certified lymphedema specialist
Vulvovaginal infections are common problems Nurses have a role in providing information that may prevent occurrence Goal:
eliminate symptoms
There are a variety of laboratory tests associated with reproductive function.
Serum levels of follicle stimulating hormone(FSH), lutenizing hormone (LH) prolactin help in diagnosing reproductive tract disorders
Structural Disorders - Male Spermatocele
Small, asymptomatic, sperm containing cyst developed on epididymis along testicle
bilateral mastectomy,
Some women with cancer in one breast may choose to have the other breast removed at the time of their mastectomy
IBC is usually classified as
Stage IIIB or Stage IV, indicating that it has metastasized to distant sites at the time of diagnosis.
Testicular Cancer Teach
Testicular screenings start at age 50 y/o
male EFFECTS OF AGING ON REPRODUCTIVE SYSTEMS decline in? hair? drooping and loss of? hypertrophy of and obstruction of ? dysfunction?
Testosterone Graying, thinning Drooping scrotum and loss of rugae Prostate gland -with possible urethral obstruction Sexual dysfunction
uses computerized mammography equipment to obtain tissue samples from non-palpable abnormalities in the breast that can be seen on a mammogram, such as microcalcifications. The patient is positioned either sitting up or lying on her stomach, depending on the equipment use. The radiologist compresses the breast with mammography plates then pinpoints the area of concern using mammography. After the area is injected with a local anesthetic, the physician makes a tiny cut and inserts a biopsy probe (large hollow needle). The probe removes several small cores of tissue from the area, which are then sent to the pathologist. This procedure generally takes less than an hour. In addition to mammogram, ultrasound and MRI can be used to guide a core biopsy. To minimize post-biopsy pain, women are advised to wear a snug-fitting bra and apply ice packs as needed
Stereotactic core-needle biopsy
psychosocial issues ___________? __________? physical? body? communication of ? threat to? concerns about? __________? avoid what? use what during therapy? community resources at? association of?
Support/Relationships Husband Physical scars Body image Communication of feelings both negative and positive Threat to sexuality Concerns about childbearing Teaching Avoid sexual intercourse for 4-6 weeks Use of birth control during therapy Community resources at local, state and national levels American Cancer Association
Surgery: the main goal
Surgery: the main goal is to obtain local control of the disease
Testicular Cancer Treatment
Surgical removal of testicle(s) chemo or radiation
NORMAL PHYSICAL ASSESSMENT OF REPRODUCTIVE SYSTEM female
Symmetric, no dimpling of breasts, soft nipples, no discharge, skin retraction, or lesions, no masses, tenderness or lympadenopathy * Triangular hair pattern, no lesions, swelling, inflammation, no discharge or tenderness *
TNM staging system
T goes through 1-4 small size mass- T1 N-how many lymph nodes involved M- has it meta sized? 0 if not T3 large mass T4 spreading metasize. all of these add together for total stage
breast self exam chart
Teach a patient and assess patient's ability to perform breast self exam An example of printed instructions to teach BSE
common site for breast cancer metastases
The lungs
how to check skin dimpling?
The patient is instructed to raise both hands overhead to elicit skin dimpling by elevating both breasts equally
significance of screening
The smaller the lump found the faster it can be evaluated, treated; improving the survival rate
Staging TNM System Tumor-Tsize
The smaller the tumor, the lower the risk of cancer recurrence and the higher the chance of survival. If it seems likely that the cancer has spread beyond the breast and lymph nodes, the oncologist may order additional blood tests, x-rays, ultrasound, CT scans, and/or bone scans to check for cancer in other organs.
Hysterectomy types and teaching
Total Abdominal Hysterectomy Uterus and cervix removed by minimally invasive surgery using laparoscopic procedure Total Vaginal Hysterectomy :removal through the vagina Teaching after hysterectomy: Physical changes expected Activity limitations Sexual activity Complications When to call provider
Many of these reproductive problems affect or even threaten sexuality and are difficult to discuss .Assessment of the male and female reproductive system should be part of every
complete physical assessment
breast cancer facts leading cause of death in what woman? Second leading cause of death in women ages?
US women 40-55 incidence increases with age n All women are at risk
what requires evaluation?
Ulcerations, rashes, or spontaneous nipple discharge
other studies
Ultrasonography MRI for pelvic tumors Endoscopic studies : § Colposcopy § Laparoscopy § Hysteroscopy
actually an FNA of a non-palpable lump or mass that can be seen on an ultrasound screen. . The ultrasound sensor (also called a transducer) is rolled over the breast until the lesion becomes visible on the screen, identifying the precise area for needle insertion.
Ultrasound-directed needle biopsy
chemotherapy
Usually a combination of agents via Central venous access device given in cycles of either every 21 or 28 days over the course of three months, six months, or one year
Female disorders
Vulvovaginitis Endometriosis Toxic Shock Syndrome Dysfunctional bleeding
lymphedema precautionary measures such as:
Weight control Avoiding arm constriction (no restrictive clothing or blood pressure cuffs on the affected side) Avoiding punctures (no injections, IVs, blood draws, or acupuncture on the affected side) Using compression garments as appropriate Avoiding extreme temperatures, such as with hot tubs Keeping the arm clean and dry; applying moisturizer daily Avoiding resting the arm below the heart or sleeping on the affected arm Wearing gloves when gardening or using household cleaners Avoiding carrying heavy over-the-shoulder bags or purses on the affected side avoid tight clothing on area, will have compression sleeves can carry out everyday activities but don't carry heavy items
Regional Recurrence
When breast cancer cells have spread to the adjacent lymph nodes (usually in the axilla) or to the chest wall, it is termed a regional recurrence
postoperative mastectomy
When the procedure is completed, one or two tubes called drains will be placed under the skin to help remove the fluid that accumulates at the site of surgery. Before patients go home, demonstrate how to empty the suction bulbs attached to the drains and how to keep a record of the volume and color of the fluid. The drains will be removed at a follow-up visit to the surgeon, or as soon as the drainage decreases. 1- 3 weeks Often analgesia is given before drains removed Jackson-Pratt bulbs: drainage should be less than 25cc in a 24 period
Patient preparation for Papanicolaou (PAP) smear teaching
Women should be taught not to douche, use vaginal preparations or deorderants, or have intercourse 24 hrs before the PAP smear is scheduled
high risk lymphedema pts
Women who are overweight or obese
Ultrasonagraphy
a method used to assess fibroids, cysts, masses in abdomen, breast and scrotum
What is the brain's role? and As with other organs in the body, sometimes things go wrong and what needs to happen?
controlling reproductive function. Both the hypothalamus and pituitary gland are involved in the control of male hormone production and sperm production. medical help is needed to correct the problem.
Fibrocystic Breast Condition
cysts • Rubbery, ill defined lumps • Upper outer quadrant of breast
Other questions to ask female patients:
about the date and result of their recent PAP smears , breast self examinations
cyclic hormone
accessory of the reproductive system and nourish the infant after birth.
The discovery of genetic mutations brings forward the importance of obtaining
accurate patient family history and referral for genetic counseling and testing when appropriate.
radiation administered doses
administer larger doses over a shorter time span (3 weeks vs. 5-6 weeks) for women with negative lymph nodes after BCS.
Hypercalcemia may indicate
advanced cancer.
The ACS (2012d) recommends women age should have a mammogram every year and should continue to do so for as long as they are in good health.
age 40 and older
The National Cancer Institute, and some—but not all—medical organizations also recommend that women begin annual mammography screening at ____ and and even earlier if ?
age 40, and family history, genetic predisposition, or previous medical treatment puts them at high risk of developing breast cancer.
Gynecomastia causes
aging, obesity, heredity malnutrition, alcoholism, drugs, meds liver disease, chronic kidney disease, hyperthyroidism
Laparoscopy
allows direct examination of the pelvic cavity through an endoscope
Tamoxifen med
alone won't cure breast cancer needs to be combined with other meds but can decrease BC by 50%
how to detect cervical cancer,
annual PAP smears especially in younger women. This is also a highly curable cancer when caught early, but it can be very deadly if not.
Monthly exam of the breasts and underarm area May discover
any changes early Begin at age 20, continue monthly
Surgical biopsies
are outpatient procedures but are usually done in the hospital or an ambulatory surgery center rather than a physician's office.
occupations sited for increasing risk for breast cancer
are textile workers, rubber and plastic makers, and women employed for more than ten years as nurses, tailors, and dressmakers.
On a mammogram, Invasive ductal carcinoma it usually appears
as a mass edged with tiny spikes (spiculation).
bimanual examination
assess the size, shape, and consistency of the uterus and ovaries
Screening recommendations have changed recently and are the point of much discussion and controversy. Organizations including the American Cancer Society, the American College of Obstetricians and Gynecologists, and the National Comprehensive Cancer Network recommend that women with an average risk for breast cancer have their first screening when?
at age 40. Earlier screening may be recommended if a woman has a higher than normal risk
Some female disorders are self limiting and cause only minor inconvenience to the patient ; others are life threatening, requiring immediate attention or long term therapy. Many disorders are managed
at home by the patient, others may require hospitalization or surgery
The American Cancer Society (ACS) recommends that women at average risk for breast cancer undergo a clinical breast exam when>
at least every 3 years in their 20s and 30s and then annually there after
A downward displacement of the bladder toward the vaginal orifice
cytocele
Lymph nodes filter out foreign substances, such as
bacteria and cancer cells, as part of the body's immune system.
the nurse recommends which self- care measures to help a patient reduce pain and manage symptoms associated with FBC? Temporarily discontinue drug therapy just before menses Take mild analgesics as needed Limit salt intake before menses to help decrease swelling Wear a supportive bra Locally apply ice or heat to provide temporary relief of pain Massage breasts frequently during peak episodes of pain
bcde
One of the biggest changes is that breast self-examination (BSE) is no longer recommended as a regular screening method for average-risk women. However, it is important for health professionals to discuss the potential ?
benefits and limitations.
The conundrum is to differentiate between
benign or hormonally related breast changes from suspicious or potential malignant changes
Based on the mammogram, the radiologist classifies the calcifications as
benign, probably benign, indeterminate, or suspicious.
Exposure to hazardous materials, such as may increase general cancer risk
benzene, styrene, solvents, dyes, radioisotopes, fertilizers, and pesticides
Patient preparation for Papanicolaou (PAP) smear The test should be scheduled when
between the patient's menstrual periods so blood flow does not interfere with analysis
Employ knowledge of human development in providing nursing care for individuals experiencing disorders of the breast: The breasts are located where?
between the second and sixth ribs over the pectoralis muscle from the sternum to the mid-axillary line.
The patient may be hesitant to discuss practices such as?. A certain level of body fat and weight is necessary for the onset of ?
binge eating, purging, anorexia or excessive exercise menses and the maintenance of of regular menstrual cycles.
A history of infections or prolonged fever in males, may have
damaged sperm production or cause infertility.
Radiation increases the risk of breast cancer both by directly
damaging DNA and by disrupting normal cellular and intracellular processes
In women disorders that affect metabolism or nutrition can
depress ovarian function and cause amenorrhea (absence of menses)
Staging
describes the extent of cancer in the body. The stage is based on whether the cancer is invasive or noninvasive, the size of the tumor, lymph node involvement, and metastasis to other parts of the body.
Serologic studies
detect antigen-antibody reactions that occur in response to foreign organisms after an infection becomes well established Useful in evaluating exposure to organisms causing syphilis, rubella, and herpes simplex
Environmental and lifestyle factors are gaining much attention in recent years related to breast cancer risk. These modifiable factors include
diet, exercise, alcohol use, and exposure to other environmental agents. DIET AND WEIGHT
Assessing the patient's health habits such as
diet, sleep, and exercise patterns are important.
One area of interest under study has been the influence of _________ on breast cancer incidence. Although there seems to be some association with ________ the results of numerous analyses have been inconsistent and additional research is needed.
dietary fat intake high-fat diets,
partial hysterectomy
discomfort after, early enough to catch takes out just uterus so they can do a vaginal hyterectomy
Although results of research indicate that BSE as a screening method has not been shown to improve survival, the fact is that many women (or their partners)
discover their own breast cancers
ACS also recommends that women discuss what with their healthcare provider.
discuss the benefits and limitations linked with yearly mammography
As patients move through the stages of life, the dialogue with providers on this topic will evolve. For instance, a conversation with a sexually active adolescent should differ significantly from a
discussion with a married perimenopausal woman.
Examination begins with inspection. The patient is asked to
disrobe to the waist and sit in a comfortable position
Serum alkaline phosphatase Calcium levels ???Elevated sedimentation rate may indicate
disseminated cancer.
If a breast lesion is large and/or locally advanced—especially if any lymph nodes are involved—then the suspicion factor for
distant metastases is raised and must be ruled out. The surgeon may order a number of blood tests to screen for signs of metastasis. For example: Sedimentation rate
postoperative mastectomy nursing care should the nurse change dressing? how often assess for drainage and bleeding? teach pt before surgery? what to discuss with women ?
do not change dressing but assess for bleeding every hour assess for drainage and bleeding teach pt before surgery: incentive spirometry, cough and deep breath will be difficult but prevents pneumonia and complications psychosocial concerns- huge concern for women loss of womanhood
Thus, the level of exposure to x-rays with mammography
does not significantly increase breast cancer risk for women who have regular screening
teaching pt about enlarged prostate
doesn't mean they have prostate cancer- they fear it. hyperplasia obstructs urine outflow, constant dribbling cant regulate, feels cant empty
Common BPH symptom
dribbling, nocturia
why Inflammatory breast cancer may have orange peeled skin?
due to malignant cells blocking lymph channels of the skin a mass and associated thickening of the breast
vulvovaginitis s/s
dysuria, odor, Vaginal discharge and itching, burning edema, excoriation redness, lesions,
Care for pt after ovarian treatment
early ambulation prevent DVT will have incisions so cough and deep breath and splint make sure BP isnt low and HFR isnt high check vs look at blood loss and temo blood loss or hemorraging can occur if vs are off risk for infection or wound dischence (reopening) due to incision or eviceration organs pop out use sterile moist dressing to cover
Reproductive factors associated with increased risk for breast cancer include
early puberty, late menopause, childlessness, and delayed childbearing. All of these factors represent exposure to unopposed estrogen, particularly estradiol. Exposure to synthetic hormones in the form of oral contraceptives and/or postmenopausal hormone replacement therapy also increases the risk of breast cancer
teaching lymhedema
finger walk using muscles up and down ROM combing hair or squeezing stress ball
milk
flows and produced from the lobules through thin tubes called ducts to the nipple.
Teaching of FBC
focuses on the symptoms -warm compress • Supportive bra reduces pain by supporting ligaments • Teach: BSE
BPH causes
from aging and androgens levels this causes enlarges gland obstructing bladder Localized inflammation -chronic urinary retention -residual urinec Primary problem: Impaired urinary elimination related to bladder outlet obstruction Can lead to complete blockage and distention of ureters and kidneys -chronic kidney disease Surgery: Transurethral resection of prostate (TURP)-enlarged portion of prostate removed Lower urinary tract symptoms
vulvovaginitis causes
fungi, bacteria, antibiotics STDs, HIV, herpes, HPV postmenopausal changes, douching, tampons, tight clothing leads to infection
A professional demeanor is important when taking a reproductive or sexual history. Being sensitive, using
gender-neutral terms when asking about partners, and having an awareness of a patient's culture and beliefs are key
Brac1 and brac2
gene we all have but when they are mutated and they get more they are at risk for BC
Pelvic Exam
general physical exam (BP, heart, lungs) May have blood/urine test Will check external genital area Digital Exam of vagina and tissues
The National Comprehensive Cancer Network (NCCN) has made available recommended criteria for
genetic testing
If pt has a nasty incision do what pap smear starts when
get a culture see whats growing may need order sexually active or latest 21 pap gets HPV testing with
HPV
get from sexual contact, may be unnoticeable on female, cure vaccinations for men and women start at 1 and up to 26. or before sexual active. gardisial recommend for both sexes
Cancer reminds us to take care of unfinished business, not only in personal relationships but also in practical matters, sometimes referred to as? Although family and friends may be uncomfortable with these discussions, they can be reassuring to the patient.
getting one's affairs in order
three way cath after TURP
goal free from clots can cause hemorrhaging because not flowing 30ml.hr of urine closed system: big bags and clamp 1. fluid goes in bladder and rinsing out so no obstruction. continuous irrigation go in frequently. to see how much is going in. tricky to see if good urine output pisten syringe. will fill with saline or sterile water and push in and pull out. get out more clots
Diagnostic breast imaging is an important tool in evaluating abnormal physical examination findings. Mammogram and how many views taken? and what happens during test?
gold standard for detecting breast cancer. it is a imaging technique used to detect non-palpable lesions and assist in diagnosing palpable masses Two views of each breast are usually taken and the breast is mechanically compresses from top to bottom and side to side which may cause some discomfort
A breast disorder, whether benign or malignant, can cause
great anxiety and fear of potential disfigurement, loss of sexual attractiveness, and even death
lobules contain
groups of tiny glands that can produce milk.
External genitalia should be inspected for
hair growth, size, shape, symmetry, skin texture, the presence of lesions, scars or swelling,
women (asymptomatic) 40 years of age and older should
have a MAMMOGRAM every year.
cardura
hert med (monitor BP and HR) relaxes smooth muscle helps urine output
ovarian cancer treatment
hysterectomy total abdominal partial hysterectomy chemo/radiation
Tissue biopsies
identification of cells in various reproductive areas. An explanation of procedural process, recovery, emotional support, discharge care instructions Patients should report s/s of infection postoperatively, since discharge is early
If pt has a discharge ask what?
if there has been heavy lifting, trauma, straining or if there is associated pain, tenderness, heaviness, tender lymph nodes
Breast Reconstruction
implant-based reconstruction and autologous tissue reconstruction (e.g., the transverse rectus abdominus myocutaneous patients should be aware there will be no return of erogenous feeling to the reconstructed nipple.
Discussing sexuality may be difficult for providers and their patients. Research suggests that communication between health care providers and patients can
improve sexual health.
Fibrocystic occurs more when?
in menstruation doesn't mean they have breast cancer. pt needs to know how they feel and wheres its at. round can be painful or not
Fibrocystic changes are identified
in the breast more frequently than any other benign breast mass
Chemotherapy drugs used to treat breast cancer
including taxanes and platinum agents, can cause damage to the nerves, leading to peripheral neuropathy
A delay or early development of secondary sex characteristics may be a familial pattern The current age and health status of family members is important Evidence of medical diseases or reproductive problems in family members ( e.g. diabetes, endometriosis, reproductive cancer)provide a fuller understanding of the patients current symptoms. Specific BRCA1 and BRCA2 gene mutations causes
increase the overall risk of ovarian cancer. Men with first degree relatives with prostate cancer are at greater risk for this disease than other men.
There are a number of ________ in the male body that act together to make up the male reproductive system.
individual organs
Nursing Diagnosis
ineffective coping related to treatment options and prognosis 1. Deficient knowledge, r/t lack of information regarding disease process, diagnostic testing, and treatment as evidenced by questions and information gathering 2. Fear and anxiety, related to diagnosis of cancer , treatments, and uncertain prognosis evidenced by verbalizations, crying, or withdrawn behaviors 3. ________________ 4. ________________ Nursing Diagnosis Ineffective Coping related to treatment options and prognosis Please list of others
*About 5%-10% of all breast cancers are caused by
inherited gene mutations.
Physical examination of the female often begins with
inspection and palpation of the breasts and axilla and then proceeds to the abdomen; and finally the genitalia.
The examination of the male external genitalia includes
inspection and palpation.
Decreased body fat results in ?
insufficient estrogen levels.
why is a dozen of different chemotherapy drugs used?
interfere with a different part of the cell's duplication process. uses two or three different drugs, affect several phases of the duplication cycle and increase the effectiveness of the treatment.
While BRCA1 and BRCA2 account for only approximately 5% of all breast cancer cases annually in the United States, those individuals inheriting these gene mutations have a 50%-87% lifetime risk of developing
invasive breast cancer
CT scans
involve the abdomen or pelvis to detect and evaluate masses or lymphatic enlargement due to metastisis
what can discharge cause
irritation of surrounding tissues, itching, pain, anxiety many caused by STD
PAP smears
is a cytologic study used to detect precancerous and cancerous cells in a female's cervix. Examination of cells from the vaginal cell walls can evaluate estrogen balance.
Gynecomastia
is the firm enlargement of glandular tissue beneath and immediately surrounding the areola
The prostate specific antigen (PSA)
is used to screen for prostate cancer and to monitor the disease after treatment
Some experts think IBC may be more common but underreported because
it can be difficult to diagnose
total abdominal hysterectomy then ileocecal resection and anastomoses can indicate
it meta sized ovarian carcinoma
with breast cancer types symptoms won't really show unless
it spreads. orange peel skin is late stage probably meta size won't notice symptoms right away if not caught in time
Finally the clavicular and axillary regions are inspected for
lesions or enlarged lymph nodes , discoloration, swelling,
Elevated serum alkaline phosphatase may signal
liver or bone metastases.
face of a clock
location used by radiologist for masses and discharge
pagets diease treatment
lumpectomy or simple mastectomy, depending on the extent of disease. Lumpectomy followed by radiation therapy is recommended to reduce the risk of recurrence
Most of the lymph vessels in the breast lead to
lymph nodes under the arm (axillary nodes).
Other imaging studies in use include? Existing research has not established these techniques as stand-alone alternatives to mammography for breast cancer screening.
magnetic resonance imaging (MRI), ultrasonography, and positron emission tomography (PET). However, these are generally used as an adjunct to mammography and primarily for diagnostic rather than screening purposes.
About 40%-60% of DCIS cases go on to become
malignant
The female breast
mammary glands develop in response to secretions from the hypothalamus, pituitary gland, and ovaries and develop during puberty in response to estrogen and progesterone.
what do breast lobes contain
many smaller lobules.
Fibroadenomas
mass of connective tissue; unattached to surrounding breast tissue comprised of both glandular and structural tissue, most common type in women 20-35 years of age.
flomax (tamsulosin)
maximizes flow relaxes smooth muscle alpha blocking drug
Erythema (redness)
may indicate benign local inflammation or superficial lymphatic invasion by a neoplasm.
regional recurrence treatment
may require surgical treatment and/or localized radiation therapy as well as systemic treatment
Edema and pitting of the skin
may result from a neoplasm blocking lymphatic drainage giving the skin an orange peel appearance which is a classic sign of advanced breast cancer
Approximately 1% of all breast cancer cases diagnosed each year are in
men
Question the patient if bleeding occurred in relation to
menstrual cycle, intercourse, trauma, or strenuous exercise Discharge can cause irritation of surrounding tissues, itching, pain, anxiety
risk Factors for Breast Cancer Race
more common in whites, Ashkenazi Jewish heritage
information about childhood illnesses that could have an effect on the reproductive system . for example
mumps in men can lead to testicular atrophy and sterility. Also , knowledge about infections can be useful.
Testing for biomarkers
ndicate specific characteristics of tumors that may help determine which adjuvant treatment would be most effective in treating and preventing recurrence of the cancer
Biopsy needle
needle Fine needle aspiration Ultrasound directed needle Stereotactic core needle
pagets disease diagnostic
needle biopsy
#1 way of diagnosing breast cancer
needle biopsy mammogram just show lesions
Patients have difficulty talking to health care providers about sexuality and sexual health for many reasons. Since most people are not raised to discuss sexual matters openly sometimes sexuality discussions are viewed
negatively.
normal physical assessment of both men and women with anus
no hemorrhoids, fissures, lesions
Discuss breast diagnostic procedures in relation to patient education: Screening for breast cancer It is important to teach women
no single method for early detection of breast cancer is effective when used alone
why is ovarian cancer usually 3 or 4 when diagnosed
no symptoms at all-asymptomatic spread to other organs. usually people don't survive spreads everywhere. went for a pap and found different cells. can try chemo but really too late
Biopsy Breast injected with radioisotope:
nodes that take up dye are removed and examined for cancer cell presence to assess the spread
Recent studies show that in the United States, The great majority of women diagnosed with breast cancer are
non-Hispanic white women have the highest incidence of breast cancer, followed by African American women, who have the second highest incidence.
types of breast cancer diagnoses what is important for classification and treatment
noninvasive =in situ : lobular and ductal (will look more defined or normal, probaby won't spread ) invasive=lobular and ductal ( more common spreads will meta size if not caught in time) others:pagets disease of nipple/areola, inflammatory, rare types, men triple assessment: palpitation, radiology (ultrasound, mammography, MRI, fine needle aspiration estrogen and progesterone receptor statuses
Cultural beliefs an practices influence lifestyle and sexual activity. A person's religious beliefs often influence specific sexual practices, the acceptable number of sexual partners, and contraceptive use. A nurse should strive to be sensiive to these differences by being
nonjudgemental and demonstrating acceptance
A man's fertility and sexual characteristics depend on the
normal functioning of the male reproductive system.
if pt has bilateral mastectomy
nothing in either arms
prevention breast cancer
obesity, not having children , breastfeeding, alcohol, exercise , hormone replacement therapy
The most common type of noninvasive carcinoma
occurs in the ducts of the breast and is called ductal carcinoma in situ (DCIS)
ASSESSMENT Subjective Data: Patient History The first health care professional to assess the patient with a reproductive system health problem or hear a patient's concern about a reproductive problem is often?
often a nurse
The ACS supports regular mammogram screening for who based on individual health and co-morbidities? and which women should having a screening mammography done with a MRI
older age women Women with known genetic mutations or other high risk factors for breast cancer
DCIS now accounts for approximately 20% of all new breast cancer diagnosed in the United States (ACS, 2012b). Ninety percent of DCIS is seen
on a mammogram as micro-calcifications.
Vulvovaginal conditions are treated how? Teaching, tact and reassurance are important aspects of care
on an outpatient basis
How is the Breast Designed. the breast sit where? and each breast is made of how many lobes?
on the chest muscles that cover the ribs. 15 to 20 lobes.
Examination of the abdomen provides an opportunity to detect
pain or any masses that may involve the genitourinary system.
Patients often seek medical attention as a result of? Pain can often be confused with?
pain, bleeding, discharge or masses GI, or GU health problems
Breast cancer types are named according to the
part of the breast in which they develop The most common forms of breast cancer come from cells that line the milk ducts (ductal cancer) or the milk producing lobules (lobular cancer) If the cancerous cells are confined to the ducts or lobules, the cancer is called noninvasive or in situ. Breast cancer that has spread through the walls of the ducts or lobules into the surrounding fatty and connective tissue is referred to as invasive or infiltrating.
For males ask about bleeding from the
penis Also, ask about other symptoms like pain, abdominal fullness, change in bowel habits, cramping, or weight changes
male reproductive system External genitalia
penis, scrotum
Information specifically related to the reproductive system and sexual issues is often required to interpret symptoms, however, are often considered extremely
personal and private or off limits like the forbidden fruit in the story of our famous friends, Adam& Eve
Encourage quality time with family
plan a trip or outing that they have always wanted to take together
NUTRITION HISTORY Nutrition history is important when assessing the reproductive health system. Fatigue and low libido may occur as a result of
poor diet and anemia.
During each procedure the nurse protects the patients privacy, explains the expected diagnostic process and recovery, assists with
positioning, and helps control pain, after care instructions for home recovery
These types of tumors are more common in
postmenopausal women
Mammography is most effective in what type of women? and has been shown to reduce the risk of dying from breast cancer in women over?
postmenopausal women 50.
The majority of breast cancers occur in what type of women? which is why mammography was initially recommended to screen women over age? However, screening guidelines have expanded to include women ages ?
postmenopausal women, 50. 40-49, as well as women in their 30s who are high risk for breast cancer
The reproductive system of both males and females consists of
primary (essential) organs and secondary ( accessory) organs
The nurse must recognize the patient's need for ? and This requires openness to discuss critical and sensitive issues with the patient as well as effective assessment, management, and communication on the part of the nurse.
privacy as well as a need for education
Elevated levels of PSA are associated with
prostate cancer (normal value less than 2.5 ng/mL)
Determine when male patients older than 50 years had their last
prostate examination and prostate specific antigen test
Structural Disorders- Female Cystocele
protrusion of bladder through vaginal wall leading to stress urinary incontinence
When efforts to slow cancer growth are no longer effective, emphasis shifts from cure or control of the cancer to providing comfort and symptom management with a goal of ?
providing the best quality of life possible during the time remaining for the patient.
Transurethral Resection preoperative reassure, answer______, inform and _______ and respect? technique ? explain? Also what way happen with catheter? possibility of?
questions, clarify, feelings and insecurities • Anesthesia, minimally invasive technique • Presence of catheter with traction and explain blood tinged urine • May be discharged with catheter • Possibility of bladder spasms
Asking whether the patient has been treated with Prolonged use of what can lead to reproductive system dysfunction would also be useful information Data about sexual activity are useful parts of the patient history. Sexual orientation should not be assumed. Patients feel more comfortable sharing information about their reproductive health and sexual activity when approached in a caring?
radiation therapy corticosteroid therapy or external estrogen, testosterone or chemotherapy drugs nonjudgemental way
Types of Noninvasive Breast Cancer Lobular Carcinoma
rare non invasive proliferation of cells within the breast lobules: no palpable lump can be seen on mammogram-increased risk for invasive carcinoma
SEXUALITY AND SEXUAL HEALTH BEST PRACTICES COUNSELING GUIDELINES Promote what type of environments? Provide current? Acknowledge ? partipate in?
sexual health in clinical practice information feelings, attitudes, norms of patient Participate in continuing education
Pagets disease
rare cancer. It primarily affects the nipple, associated with underlying breast malignancy gradual onset over months or years misdiagnosed, as dermatitis, delaying proper diagnosis. If cancerous changes are confined to the nipple, the prognosis is excellent. If a breast mass is present, the cancer may have spread to the axillary nodes or beyond.
When palpating if Any enlarged lymph nodes are noted? If a mass or nipple discharge associated with palpation of a mass is detected, it Is thoroughly described by
reference location, size, consistency, mobility and patient reported tenderness it's location (e.g. left breast-2 cm from nipple-at 2 o'clock position)
M
refers to any distant metastasis
Cyclic hormone changes lead to what type of changes?
regular changes in breast tissue to prepare for lactation once fertilization and pregnancy occur
Conditions that change vaginal pH Goals: Relief of? reduce what? prevention of? acquisition of ? what measures?
relief of discomfort reduce anxiety r/t symptoms Prevention of reinfection Acquisition of knowledge about prevention methods Self care measures
preoperative surgery
relieve anxiety Education: • Incision/wound • Drains • Mobility restrictions • Hospital stay period • Adjuvant therapy
simple mastectomy
removal of the breast tissue, skin, areola, and nipple, but not the lymph nodes
radical mastectomy
removal of the entire affected breast, the underlying chest muscles, the lymph nodes under the arm (axillary node dissection), along with some additional fat and skin
modified radical mastectomy
removal of the entire breast, including the skin, areola, and nipple, along with the axillary lymph nodes, but leaves the chest wall muscles intact
prophylactic
removal of the other breast preventive measure. reduces the risk of breast cancer recurrence, but it is not an absolute guarantee because of the systemic nature of the disease.
*Modified Radical Mastectomy*
removes as much of the breast tissue as possible, including the nipple and the areola, and a number of axillary lymph nodes, but not the muscles. Used when tumor > 5 cm
FAMILY HISTORY AND GENETIC RISK The family history helps determine the patients risk for conditions that affect
reproductive functioning
Uterine Fibroids occur during what years
reproductive years with Myomatous or fibroid tumors Genetic predisposition Lupron side effects-hot flashes, vaginal dryness monthly injections
Muscle tears below the vagina causes rectum to pouch upward pushing posterior wall of vagina forward
retocele
Benign calcifications tend to be
round or oval, uniform in density, and scattered in the breast tissue.
Preoperatively the nurse would: Provide what environment for patient ? relieve?
safe environment so pt can talk openly about his /her feelings Relieve anxiety Realize that a cancer diagnosis of any type is likely to create a whirlwind of emotions for the patient; fear, shock, anger, anxiety, denial, depression Many women are surprised by the diagnosis since they feel healthy without unpleasant signs and symptoms Assessing and being sensitive to the patient's emotional health is essential Assess learning needs and readiness to learn/direct to reliable sources of information-allow for privacy Teaching topics Blood tests, urinalysis, ECG, NPO, shower with antibacterial soap, surgery lasts 1-2 hrs, depending on type -hospital stay is overnight without complications Incision/wound; observe for s/s infection, integrity, poor healing Drains-postop hospital and home Mobility restrictions-reducing risk of lymphedema, exercises for range of motion Hospital stay period -routine postoperative monitoring Discuss postoperative care at home-reinforce postoperatively Adjuvant therapy Support group contact-photographs of women who have had Include significant other in teaching unless not culturally appropriate
pagets s/s
scaly,crusty flaky, erythematous lesion, itching or burning with superficial erosion or ulceration. sometimes no breast mass.
A comprehensive breast evaluation is required for both
screening examinations and diagnostic assessments.
Widespread use of ____________ has dramatically increased the number of known cases of DCIS since 1973,particualry in what type of women?
screening mammography premenopausal women.
A CBE should be performed in conjunction with
screening mammography.
MRI
screening tool provides an addition to screening mammography to screen high risk asymptomatic women or diagnose women with breast abnormalities
Genetic counselor may be needed to explore close surveillance as
secondary prevention measure
The breasts are a
secondary sex characteristic
Benign Prostatic Hypertrophy s/s
sensation of incomplete emptying straining to start stream post void leaking reduced force of stream difficulty starting urine stream
Chemotherapy-induced peripheral neuropathy
sensory neuropathies, including paresthesias (burning, tingling, and numbness) and pain starting in the fingers and toes, which can spread proximally
Disorders of the female reproductive system can be minor or serious and can cause anxiety and distress. Many female disorders impair?
sexual function leading to strained relationships
*Breasts play an important role in defining? and breast has a erroneous significance in what as well?
the special functions of a woman's body and culture
SEXUALITY AND SEXUAL HEALTH BEST PRACTICES COUNSELING GUIDELINES Be aware of and respect patients Take care to provide Listen and interpret patients
sexual values and lifestyles unbiased, comprehensive care ' sexual values, experiences and concerns
*Breasts are a part of the females ?
sexuality and identity regardless of race, age, religion or ethnicity
Suspicious microcalcifications may vary in
shape, size, form, and density and are usually clustered in a linear or segmental pattern.
There are three types of mastectomy:
simple, modified radical, and radical.
During inspection the breast are compared for?
size, shape and symmetry -slight variations are normal
In the age group over 50, mammography can detect
slow-growing breast tumors, which are less likely to be fatal, at least two years before they reach palpable size.
normal physical assessment of male breast
soft nipples, no lumps, swelling, or enlarged tissue noted
Endoscopic studies
specific to certain body areas may also be performed diagnostically: colposcopy-female cervix, vagina, vulvar epithelium
danocrine s/s
stroke, liver disease, and increased intracranial pressure
Biomarkers
substances (i.e., hormone receptors or growth factors) that are present in the cancer cells and help the cancer grow and spread.
Patients with recurrent or metastatic breast cancer need support and understanding more than ever, not only from family and friends but from health professionals as well. They need to be able to talk openly about their cancer, their feeling and concerns, their care preferences, and their decisions about ending treatment. Helping patients and their family members change their focus from seeking cure to seeking the best comfort and quality-of-life measures with end-of-life care is paramount. Because this can be very stressful for some people, they may require support from various resources,
such as social work, certified counseling/psychotherapy, peer support groups, and chaplains.
Women have special nutritional needs . Heavy menstrual bleeding in women who have intrauterine devices, may require ? All women should be taught about the body's need for ?
supplements. calcium, especially during and after menopause to prevent osteoporosis due to decreased estrogen production.
Cooper's ligaments
support the breasts on the chest wall. A ridge of fat outlines the bottom edge of the breast.
biopsy surgical
surgical • Needle localized • Excisional
total abdominal hysterectomy
take out everything ovaries, uterus, fallen tubes. preferred treatment. recovery hard "bilateral mactecomy or richest-my"
For average-risk women,general breast awareness is recommended, which includes regularly ? Women should be aware of how their breasts look and feel and report any changes to?
taking note of any breast changes (such as shape or feel) while getting dressed or showering. their healthcare provider for a clinical examination. Finding a breast change does not always indicate breast cancer
Trastuzumab
targeted approach to treatment that is classified as a monoclonal antibody. Via Central venous access device (port-a-cath)
male reproductive system internal genitalia
testes and prostate gland Inguinal area
From birth to old age, breast anatomy goes through more changes
than any other organ in the body.
As with the female, what also has an important role in controlling reproductive functions in the male.
the brain
During reproductive years, variations in the levels of these hormones cause
the breasts to go through monthly cycles; milk glands engorge when getting ready for pregnancy, then return to inactive state.
The awareness of this finding with subsequent decrease in use of these exogenous hormones in postmenopausal women no doubt contributed to
the drop in incidence of breast cancer,
Lymph nodes and the lymph vessels drain
the excess fluid that is not absorbed by blood vessels.
At menopause what happens?
the hormone levels drop, and milk producing glands shrink, and some of the breast tissue is replaced with fat.
Age affects the functions of both
the male and female reproductive systems. Many changes in the reproductive system occur as people age
Some of the male sexual organs are visible, such as
the penis and the scrotum, whereas some are hidden within the body.
Ask about history of chronic illnesses or surgeries that could affect
the reproductive function.
For many women, making the decision to stop cancer treatment that is no longer working can be a powerful step to be free
the side effects of treatment and take control of their lives.
Diagnosis of DCIS depends on the pathologist's interpretation of biopsy results and may be controversial. Second opinions are important because appropriate treatment depends on an accurate diagnosis. Patients seeking a second opinion should arrange
to take their tissue slides and tissue blocks containing cell samples to a second pathologist.
N refers
to the axillary lymph node involvement
TURP
transurethral rescetion of prostate will help resect some of prostate will need some male hormones from prostate thats why it isnt removed. they will have better urine output. going in urethra and resect and come back with 3 way catheter
The T refers to
tumor size
Cytologic cultures
used to detect bacterial, viral, and fungal disorder.
Hysteroscopy:
uses a fiberoptic camera to visualize the uterus to diagnose and treat causes of abnormal bleeding
MRI
uses a magnettic field of radiofrequency to scan for pelvic tumors and can distinguish between normal and malignant tissues
Brachytherapy
uses radioactive pellets or seeds that are temporarily placed in the breast tissue adjacent to the cancerous area or in the space where the tumor was removed
Pelvic organ prolapse- Uterine Prolapse -Usually the uterus and the cervix lie how? to the long axis of the vaginal with the body of the uterus ? when examined whats normal with the uterus? -If the structures that support the uterus weaken the uterus what happens?
uterus comes out at right angles inclined slightly forward -the uterus is usually freely movablse may migrate down the vaginal canal (prolapse)-pulls on vaginal walls and may bring bladder and rectum with it as it descends
Structural Disorders- Pelvic Organ Prolapse uterine prolapse cause
uterus comes out due to aging or too many babies Neuromuscular damage of childbirth, increased intra- abdominal pressure secondary to pregnancy, obesity, physical overexertion, weakened pelvic support teach kegels when young or when pregnant
Patients with diabetes mellitus may experience physiologic changes Chronic disorders of the nervous system, respiratory system, or cardiovascular system can alter?
vaginal dryness or impotence. sexual response.
During inspection the skin is inspected for?
venous pattern, or edema color, thickening
Those known to have genetic mutations require
very diligent monitoring and present the possibility of prophylactic measures such as bilateral mastectomy and/or oophorectomy.
Clinical Breast Examination is what type of exam?
visual inspection of the breasts, noting any changes in shape, size, and appearance.
Speculum used to observe
walls of the vagina and cervix for inflammation, discharge, polyps, and suspicious growths During this exam a PAP smear is often performed to collect cells for culture and microscopic examination
sexuality forbidden fruit Sexuality is the complex integration of many physiological, social, and cultural aspects of well being. It is closely associated with self-concept, self esteem, role relationships, sexual response, gender identity, and reproduction. A nurse is often among the first contacts patients communicate with
when reproductive concerns or sexuality issues exist
Although mammograms can detect calcifications, it is only a biopsy can determine
whether they are DCIS
All disorders require that mature nurses who have knowledge, understanding, skill and who are in touch with their own sexuality in order to deal effectively and sensitively when discussing and dealing with women presenting with reproductive concerns Some of the minor disorders
which may not be seen in a hospital setting
Encourage time with friends
who are supportive
Examination of external genitalia in men may be performed how?
with the patient lying or standing.
BSE is recommended for who?
women of all ages who are at high risk for developing breast cancer.
Create a living legacy to leave for family members
writing letters or recording family stories or videotaped messages
IBC is more common in and Once a uniformly fatal disease with only an 18-month survival rate from time of diagnosis, IBC can now be treated more effectively.
young African American women than in white women. It is also more commonly found in overweight or obese women.
asSESSMENT TECHNIQUES: FEMALE physical assessment:
§ Breast examination § Abdominal examination § Examination of external genitalia
ASSESSMENT TECHNIQUES: FEMALE Not usually performed by nurse generalist
§ Internal pelvic examination § Bimanual examination § Rectovaginal examination
Structural Disorders- Female Management cyctocele rectocele pelvic organ prolapse fibroids training of? Improved/facilitated? improve muscle strength of? therapy of? what devices used? what type of repair? postmenopausal women may choose?
• Bladder for complete emptying • bowel elimination using high fiber in diet and stool softeners • pelvic floor doing Kegel exercises • Intra-vaginal estrogen therapy usually postmenopausal to avoid atrophy and weakening of vaginal walls • Space filling devices (pessaries) worn in vagina to elevate uterus and bladder • Transvaginal or anterior surgical repair for severe symptoms • to remove (hysterectomy)or repair
postoperative care plan Assess incision and skin flap for integrity:
• Bleeding, hematoma • Infection signs and symptoms: • Poor tissue perfusion Ambulation with arm support Regular diet
Intraductal papilloma s/s
• Bloody or serous nipple discharge
End of life planning: what directives? do not? issues? planning? ______? donation of? _________?
• Advance directives • Do not resuscitate • Legalissues • Wills/estate planning • Hospice • Organ donation • Funeral and memorial
Risk factors?
• Age and Gender • Marital status • Weight and Height • Knowledge of genetic mutations: BRCA1 or BRCA2 • Medical history -Personal/family history of breast, childhood, or ovarian cancer h/o chest radiation -ETOH use/abuse? Prescribed or OTC medications? Oral contraceptives/Hormone replacement therapy? Smoking history? Diet? -OB/GYN history, menarche, menopause onset, parity, age at first birth, prolonged stimulation, breastfeeding history, date of last menstrual period, cycle regularity
RISK FACTORS THINGS AT HOME
• Antiperspirants • Underwire bras • Hair dyes
*lymphedema causes*
• Arm injury on affected side • Aging • Tumor in upper outer quadrant • Implanted CVAD • Inflammatory changes • Scarring from chemotherapeutic agents • Spread of metabolic disease
Prostate Cancer postoperative asess for? what med can be given? assess pt with? what can prevent constipation? monitor? teach what? what also needs to be taught?
• Assess pain: opiods • Antispasmodic for spasms • Assist with ambulation • Stool softener prevent constipation • I&O- foley catheter care/monitor • Teach kegel exercises, urinary cather care at home • Elevation and ice application for swelling of scrotum or penis
nuring management *lymhedema Monitoring/Management*
• Assess tissue perfusion and capillary refill • Arm exercises and elevating arm above heart several times per day • Teach: prevention of trauma to affected arm • Inspect skin of skin color, texture, integrity • Measure circumference of extremities prior to surgery or radiation and at intervals to compare
what causes breast cancer
• Breast cancer is always caused by a genetic abnormality (a "mistake" in the genetic material). • However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. • About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the "wear and tear" of life in general.
Fibrocystic Breast Condition s/s
• Breast pain Area of breast thickening Tenderness • Cysts filled with fluid • Hard fibrous tissue
Fibroadenoma management
• Breast ultrasound • Needle aspiration are done to establish if lump is solid or fluid filled • Excision is treatment of choice often of lump is solid, outpt basis under local anesthesia
imaging for Metastases
• Chest x-ray • Bone scans • CT of liver, brain • PET scans
Benign Prostatic Hypertrophy
• Chronicurinary retention and stasis - residual bladder urine • Incontinencefrom overflow may lead to blockage, dilation and chronic kidney disease
Screening For Breast Cancer A Good Breast Health Plan The best approach for average at risk women is screening:
• Clinical Breast Examination (CBE) • Self Awareness (Monthly Self Exams) (BSE) • Mammograms (imaging studies)
lymphedema s/s
• Complains of heaviness or ache • Tightness feeling more pronounced skin folds • Jewelry or clothing tight
Uterine Fibroids treatment
• Conservative at first • Hysterectomy: if symptoms continue and childbearing years over(if recurrent) • Lupon injection to induce shrinking of tumor by inducing a temporary menopause state • Psychological assessment: may interfere with fertility • Myomectomy: surgical removal fibroid laparoscopic++++mim invasive • Tumor shrinkage process
Rectocele s/s
• Constipation • Hemorrhoids • Fecal impaction • Feelings of rectal or vaginal fullness • Bulge of posterior vaginal wall with bearing down • Ulceration, bleeding • Rectal pressure • Painful intercourse
Endometriosis treatment
• Contraception to control menstrual cycle and regulate hormones #1 • Relaxation techniques • Heat pack application, abdomen, back • Mild oral analgesics: NSAIDs • Danocrine(Danazol): atrophy of endometrium • Surgery: laparoscopic removal of implants and adhesions/ ablation/ hysterestomy
management SE of Chemotherapy correct? what growth factors used? give what ? avoid? support? appearance? reduction of? s/s of?
• Correct cachexia,depression, insomnia, electrolyte imbalances • Hematapoietic growth factors to minimize neutropenia and anemia • Anti-emetics • Avoid crowds, wear mask, hand washing • Rest, support coping • Wigs, short haircut • Dose reduction • s/s of anemia, infection-
BPH Diagnosis
• Digital rectal exam: uniform elastic, non-tender enlargement Massage during exam to obtain fluid sample for culture and sensitivity to r/o prostatitis • Prostate specific antigen (PSA): r/o cancer • BUN and creatinine : to evaluate renal function • Bladder Ultrasound, cytoscopy, urodynamic studies • CBC: r/o infection
adjuvant Therapy Targeted therapy
• Drugs target specific characteristics of cancer cells • Herceptin: HER2 gene • Avastin:inhibits tumor growth factor and stopping formation of blood vessels that nourish tumor
nursing mangement: preoperative biopsy encourage what? what type of needs? how to alleviate anxiety? provide what to patient? what type of instructions does patient need?
• Educational • Encourage verbalization of fears, concerns, questions • Physical • Psychosocial needs • Provide explanations to alleviate anxiety • Provide written instructions, information to reinforce teaching • Preoperative procedure instructions
Female Vaginal Disorders vulvovaginitis treatment
• Eliminating source and remove irritant or allergen • Application of wet compresses, sitz baths, topical medications like estrogen, lidocaine • Antifungalagents: Monistat or antibotics
Endometriosis
• Endometrial tissue implanted outside uterine cavity (endometriosis outside uterus) • Tissue found implanted on ovaries, cul-de-sac, other pelvic structures, spine • Menstrual bleeding occurs at ectopic site scarring tissue • Adhesions lead to infertility • Pain
ways to Maintain Hope and Connection to Others family? focus on? ________? creation of? __________?
• Family time (trips, outtings) • Focus on pain symptom relief/comfort • Communication • Legacycreation • Friends
short term effects of radiation therapy
• Fatigue • Lung, nerve damage • Arm Swelling, redness, bruising, blistering, infection • Breast Pain • Skin reactions edu-harsh soaps and lotions/irritation/soreness/peeling decreased sensation or hypersensation
Why women do not practice BSE
• Fear • Embarrassment • Youth: not realizing the importance • Lack of knowledge • Too busy, forgetfulness
adjuvant Therapy Targeted therapy s/s
• Fewer side effects because it does not harm normal, healthy cells • Side effect risk: cardiotoxocity
Toxic Shock Syndrome Treatment:
• Fluid and electrolyte replacement • Eliminate sourceof infection: tampon** • Corticosteroids to treat skin changes • Can be fatal • IV antibiotics*** • Transfusion to reverse low platelet count • Prevention re: prolonged tampon use
Cystocele s/s
• Frequency and urgency • Urinary tract infections • Large bulge at anterior vaginal wall when bearing down • Difficulty emptying bladder
psychosocial Issues: support gather? consider? patients make? the journey is? keeping of ?
• Gather information • Consider treatment options • Stress there is support • Patients make individual choices • The journey is personal and unique Record keeping: • Treatments/Procedures • Medications/Appointments • Labs/Diagnostics • Insurance/Legal/Journal
patient Education for Skin Reactions to Radiation do what after bathing? avoid what on radiated side? wear what type of clothing? avoid what on the treatment area? during radiation treatment avoid what? always protect the radiated area from exposure to what? promptly report what to primary care provider?
• Gently pat skin dry after bathing • Avoid deodorant or talcum powder on the radiated side • Wear soft clothes and use cotton sheets • Avoid adhesive tape, bandages, or other types of sticky tape on the treatment area • Avoid chlorinated swimming pools and hot tubs during radiation treatment • the sun or tanning beds, even after treatment ends • pain, swelling, exudate, or other skin changes
Ductal Ectasia s/s
• Greenish brown nipple discharge • Redness • Edema over site of mass
male breast cancer risk factors
• Gynecomastia • Undescended testicles • Mastitis • BRCA1 mutation manifestations Orchiectomy • Infertility • Chest wall trauma
postoperative care plan Positioning for comfort and to facilitate drainage:
• HOB elevated 30 degrees • Arm elevated on pillow Assess for pain: analgesics as prescribed
Ductal Ectasia
• Hard, tender mass with irregular borders • Enlarged axillary nodes/blocked duct
Toxic Shock Syndrome Signs/symptoms:
• Headache, fainting • Abrupt onset high fever • Flu-like symptoms • Severe hypotension • Sunburn-like rash in eyes and on skin
BPH Goal: normal urinary elimination pattern surgical
• Heatablation techniques shrinks or vaporizes excess tissue • Stentstomaintain patency • Resectionofprostate
*lumpectomy* how many weeks of radiation after surgery
• If the tumor is small and confined to a single location in the breast, breast- conserving surgery, also called a lumpectomy. • The goal of this relatively simple procedure is to remove the whole tumor, while conserving as much breast tissue as possible. • A margin of normal breast tissue is also removed to make sure no malignant cells are left behind. 5-6weeks of radiation after surgery
Female Vaginal Disorders vulvovaginitis
• Inflammation of lower genital tract from hormonal disturbance and flora
Infiltrating Ductal Carcinoma s/s
• Irregular,poorly defined mass (abnormal look) • Fibrosis shortens ligaments causing dimpling seen on skin/orange peel skin peau d orange changes noticeable • Edematous thickening and pitting of skin
diet FBC
• Limiting salt intake before menses to reduce swelling • Limiting dietary caffeine and fat intake
Recurrent Breast Cancer
• Local • Regional • Metastatic • Surgery • Highdosechemotherapy • Palliativecare
Uterine Fibroids s/s
• May cause pelvic pressure sensation abnormal bleeding • Urinary frequency • Enlarged uterus • Pregnancyhormones enhance growth, shrink with menopause
When to do BSE
• Menstruating women- 5 to 7 days after the beginning of menstrual period • Menopausal women - same date each month • Pregnant women - same date each month • Takes about 10 minutes • Perform BSE at least once a month • Examine all breast tissue
Ductal Ectasia management
• Microscopic analysis of nipple discharge to detect abnormal cells • Area excised or surgically removed if no improvement • Support: reduce anxiety
Intraductal Papilloma management
• Microscopic examination of nipple discharge • Surgical excision of mass or ductal area if needed
RISK FACTORS PLACES
• Night-Shift Work- decreased levels of melatonin as workers are exposed to light during normal sleeping hours • Occupation melatonin production, which aids in sleep and usually peaks between the hours of 1:00 and 2:00 a.m.
Benign Prostatic Hyperplasia and test
• Nodular tissue hyperplasia and increased androgens; seen as men age • Localized inflammation • Digital rectal exam:large, non-tender prostate gland rubbery
genetic risk: HER2 Gene
• Normally found in breast tissue • Involvedwithcelldivision • In20-30%ofwomenwithbreast cancer the HER2 gene is amplified or overexpressed
Structural Disorders - Male Varicocele treatment
• Not needed unless patient not tolerant • If painful or cause of infertility, surgical removal may be done, may remove veins increase sperm/sterility , don't use hot tubes
Structural Disorders of Reproductive System-Male Hydrocele treatment
• Only when bothers patient • If swollen and obstructs blood flow, it may be drained or surgically removed
Types of Noninvasive Breast Cancer Ductal Carcinoma
• Originate in ducts that carry milk to nipples • If cancer confined to duct = in situ (DCIS) • Usually found on mammogram • If moved beyond duct = invasive or infiltrating
IBC: Infiltrating Ductal Carcinoma
• Originates in mammary ducts and grows in epithelial lining • Irregular pattern of growth continues in surrounding tissue
nurse management postoperative biopsy management of? review? inspect surgical site for? monitor effects of? assist with providing? return visit to review? what women wear?
• Pain management • Review activity restrictions • Inspect surgical site dressing for bleeding • Monitor effects of anesthesia • Assist with providing oral fluids, ambulation, voiding •.Return visit to review pathology report biopsy site healing, review incision care • Supportive bra Can return to normal activities but must avoid high impact jarring activities for 1 week to promote biopsy site healing If a diagnosis of cancer is made preoperative preparation for surgery may begin
diagnose biopsy
• Pathologicalexaminationof the breast tissue is the only definitive way to diagnose breast cancer
goals
• Patient verbalizes understanding of disease, diagnosis, treatment options, and prognosis • Patient demonstrates reduced level of anxiety evidenced by use of positive coping strategies • Patient verbalizes feelings related to body image changes and accesses available resources to assist in related lifestyle adjustments • Patient verbalizes adequate pain control on a 0-10 pain scale and demonstrates effective use of pain management techniques
Clinical Breast Examination (CBE)
• Performed by doctor or trained nurse practitioner skilled in technique • Annually for women over 40yrs • At least every 3 years for women between 20 and 40 years • More frequent examination for high risk patients
Prostate Cancer treatment
• Prostatectomy • Bilateral orchiectomy (testicle removal) slows cancer spread by removing source of testosterone) • Radiation or hormones or chemotherapy medications may be used as a palliative measure
radiation therapy
• Radiation therapy uses high-energy beams to destroy cancer cells. • The beams resemble the X-rays that are used to create an image of the chest, or of a broken bone. • For treatment purposes, the rays are of higher intensity.
Reproductive Cancer - Females Ovarian
• Rapid bilateral disordered epithelial tumor growth on ovary surface due to excessive estrogen exposure • Vague abdominal symptoms
Prostatectomy preoperative reduce?? explain??? relieve of what and with what?
• Reduce anxiety, explain process and treatments, expected outcomes • Relieve discomfort: pain medications, anti- anxiety medications, catheterize if needed
Nursing Management Outcome
• Reduced discomfort • Free from infection • Self care
Breast Physical Examination: Palpation positions? what needs to be symmetrically palpated?? palpate with? exams can be either? If a mass is detected do what?
• Sitting upright • lying Supine with shoulder elevated on a pillow to balance breast on chest wall • Entire surface of the breast and axillary tail systemically palpated using flat pads of fingertips ( exams can either be concentric circles from outer edge inward toward nipple or along side imaginary vertical strip methods) • Palpation of axillary and clavicle areas for enlarged lymph nodes • describe by size, shape,borders, consistency, location, mobility
Inflammatory Breast Cancer (IBC)
• Swelling • Skin redness • Pain, diffuse edema • Does not always present as a palpable mass or on mammogram -warm over breast This rare and aggressive subtype may be mistaken for an infection
psychosocial Issues: Discussions
• Telling family and friends • Informing an employer • HIPAA
Hysterectomy Postoperative what to observe? assess what site? incision monitor for? monitor for what if inserted? assessment of? what care should be given?
• Vaginal pads less than one saturated pad in 4 hours • Abdominal or lap incision site assessment • Integrity/intactness of incision • Urine output/foley if inserted • Pain assessment &relief • Perineal care
Vulvovaginitis Diagnosis
• Vaginal smear of discharge to identify causative organism • r/o urinary tract infection, STD
treatment FBC
• Vitamins C,E B complex • Mild analgesics • Oral contraceptive • Local application of heat or cold Danocrine • Diuretics
Ductal Ectasia treatment
• Warm compresses • Antibiotics
patient Education for Skin Reactions to Radiation wash how? how often to shower? and how often to bath? avoid what? be careful not to? what should you wash off? avoid to what exposure, and protect their skin from
• Wash the radiated area gently with warm (not hot) water and a mild soap such as Ivory, Pears, or Neutrogena • Don't shower more than once per day; limit baths to twice weekly for less than 30 minutes per bath • Avoid rubbing, scrubbing, or scratching the skin • Be careful not to wash off the ink markings needed for radiation therapy • Wash off any lotions or creams from sites prior to RT, as their presence can intensify burns -sun and extreme temperatures (such as a hot bath or hot shower)
Selected Estrogen Response Modifiers s/s
• hot flashes • weight gain • Endometrial cancer • Thromboembolic events
Hysterectomy Preoperative explain what? reassure? teach? assess? last?
• routine preoperatively (labs, preps, antibiotics) • explain,define as needed • Turning, coughing, deep breathing, spirometry, ambulation, pain relief • Assess psychological readiness, coping • Supportsystem
Transurethral Resection postoperative assess? assess what with catheter? urge what with its? monitor what labs? observe for s/s of? remind patient of what urge?
• vital signs and level of pain • traction maintenance and assess urine every 2 hrs. for color, amount, passage of small clots and tissue shreds • Urge fluid intake to 3 L/day to clear urine • Monitor Hemoglobin and hematocrit and Transfusion if needed • Observe for s/s infection and incontinence * void sensation related to catheter and tension on catheter*
follow up care
• • • • • Education • Encouragement • Referrals: support groups, reliable websites • Know symptoms needing attention increase self efficacy Focus on wellness Counseling Rash, abdominal or bone pain, swelling, redness, edema, new lumps or changes, weight loss Surveillance,screenings
*surgery*
•Lumpectomy •Modified Radical Mastectomy •Radical Mastectomy (rare) Reconstruction -total/partial mastectomy
adjuncts to surgery
•Radiation Therapy •Chemotherapy •Hormonal Therapy All are options for adjuncts to surgery depending on stage of cancer
*treatment for breast cancer*
•Surgery • Radiation Therapy • Chemotherapy=surgical port for chemo • Hormonal Therapy modified racial mastectomy /prophylactic surgery-remove both breast females choice
Nursing Management evaluation' urine output? no s/s of? what to use only if prescribed? reports and relieve ? avoid what type of sex? wear what type of undergarments? clean premium how? take what as prescribed? and teach what?
•WNL • inflammation, odor, discharge, dysuria, fever • Douches only as prescribes • Reports pain and itching relieved • Avoids unprotected sex • Wears absorbent undergarments • Cleans perineum front to back • Takes medication as prescribed: teach about vaginal suppositories, creams and applications
