Nursing care plan mastectomy

I. Purpose
a. Removal of breast tissue due to presence of malignant or
cancerous tumor changes
b. Surgical procedures: dependent on tumor type, size, and
location as well as clinical characteristics or staging
i. Breast-conserving therapy
ii. Lumpectomy
iii. Partial or segmental mastectomy
iv. Lymph node surgery
v. Mastectomy (Mayo Clinic, 2007)
1. Simple or total
2. Modified radical
3. Radical
4. Skin-sparing mastectomy

II. Pathology—Tumor growth originates in cells of the breast
tissue occurring primarily in women, although men may also
be affected.
a. Types (National Comprehensive Cancer Network [NCCN],
2007)
i. Ductal
1. Occurs in the ducts that connect the lobes and the
nipple
2. Represents 80% of all breast cancers (invasive ductal
carcinoma)
ii. Lobular
1. Occurs in the lobes where milk is produced
2. Represents 10% to 15% of all cancers
b. Clinical staging (NCCN, 2007)
i. Classification: noninvasive, invasive, or infiltrating
ii. Size and spread of tumor: T stage
iii. Number of lymph nodes involved: N stage
iv. Metastasis: M stage
v. Grade measured from 0–IV, with zero resembling
normal breast tissue
vi. Some stages further divided by letters of the alphabet
(A, B, C, etc.)

III. Statistics (National Cancer Institute [NCI], 2008)
a. Morbidity: As of January 2005, approximately 2,477,847
American women had a history of breast cancer; in 2008,
an estimated 182,460 new cases of breast cancer were
diagnosed in women and 1,990 in men.
b. Mortality: In 2007, breast cancer was the second-leading
cause of death in women in the United States; an estimated
40,480 women and 450 men died of breast cancer in 2008.
c. Cost: Projected $8.1 billion spent in United States in 2004,
averaging $11,000 per Medicare client in first year following
diagnosis (Brown et al, 2002)

Care Setting
Client is treated at inpatient acute surgical unit.

Related Concerns
Cancer, (for additional nursing interventions
regarding cancer treatments, including chemotherapy and
radiation)
Psychosocial aspects of care
Surgical intervention

Nursing Priorities
1. Assist client and significant other (SO) in dealing with
stress of situation and prognosis.
2. Prevent complications.
3. Establish individualized rehabilitation program.
4. Provide information about disease process, procedure,
prognosis, and treatment needs.

Discharge Goals
1. Dealing realistically with situation.
2. Complications prevented or minimized.
3. Exercise regimen implemented.
4. Disease process, surgical procedure, prognosis, and therapeutic
regimen understood.
5. Plan in place to meet needs after discharge.

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