The Care of a Patient with Breast Cancer and Lymphoedema Essay Example
The Care of a Patient with Breast Cancer and Lymphoedema Essay Example

The Care of a Patient with Breast Cancer and Lymphoedema Essay Example

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  • Pages: 7 (1732 words)
  • Published: August 14, 2018
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Irene, a 33-year-old married woman, has two young children. Her children include a six-month-old and a five-year-old.

Recently, Irene has been attending the surgical outpatient clinic to investigate a lump in her right chest. During her visits, she has expressed concern about the impact of the lump on her chest. Consequently, she has received a diagnosis of breast cancer and is now admitted to the breast surgery ward for treatment. Irene's scheduled surgery involves making a wide local incision to remove both the breast lump and any adjacent cancerous tissue. Moreover, an auxiliary clearance (lymph node dissection) will be performed (Tschudin, 1996).

Concerns have been raised by Irene regarding the possibility of her arm swelling (lymphoedema) after surgery and how it will impact her ability to interact with her baby. As the nurse overseeing Irene's care, a comprehensive plan has been devised to ad


dress both immediate and potential complications related to this surgery. This plan incorporates nursing interventions that are tailored specifically for Irene. However, this assignment will primarily concentrate on two key postoperative problems: pain and discomfort, which are frequently linked to this particular type of surgery (Tschudin, 1996), as well as lymphoedema.

Irene has raised personal concerns about these jobs, which will now be dealt with. Pain is defined as an unpleasant subjective sensory and emotional experience linked to actual or potential tissue damage, or described in terms of such damage (ISAP. 1979).

According to Logan (1995), Irene will undergo pain and discomfort due to her breast cancer surgery, making it crucial to prioritize proper pain management (Mallett & Dougherty, 2000). Alexander et al. (1994) further explain that pain can be classified as acute or chronic an

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may also have psychological effects on the patient. They define acute pain as the pain occurring after an injury.

Both acute pain, which is caused by injuries or surgeries and occurs suddenly, and chronic pain, associated with long-term diseases like cancer, can have psychological effects. Acute pain leads to fear and anxiety while chronic pain lasts for more than six months, varies in intensity, and induces psychological effects including anxiety and depression.

According to Kweekeboom (1996), Irene's pre-existing condition of being terminally ill may increase the likelihood of experiencing pain after surgery due to anxiety. Anxiety causes muscle tension and induces pain. However, offering support and information to the patient before the operation can reduce both anxiety and postoperative pain (Heath, 1995).

Phipps et Al (1995) also support this notion and suggest that patients who are given information about an outward feeling like pain perceive the actual experience as less unpleasant. Therefore, Irene should be informed prior to her surgery of what she can anticipate in terms of post-operative pain. It should be explained to her that pain may occur in the surgical area, specifically in the chest, arm, and shoulder (Logan).

According to Walsh (1997), the patient from 1995 would also be informed about available pain relief options. She would also be encouraged to communicate any concerns and actively participate in her own pain management. Written information should be provided to the patient and her family, as well as a recommendation for a support group for additional advice and support. Meinhart ; McCaffery (1983) emphasize the importance of effectively controlling acute surgical pain.

Importantly, the pain assessment and cooperation from the entire healthcare team are necessary. When Irene is

brought back to the ward after surgery, a pain assessment will be conducted. According to Heath (1995), the nurse should observe and ask the patient questions to determine the onset, duration, and location of pain. A baseline assessment should be performed and recorded, and regular follow-up assessments should take place to evaluate effectiveness compared to the baseline. Additionally, Heath (1995) suggests that the intensity of pain should also be evaluated, and pain assessment tools can effectively accomplish this.

The Verbal Pain Scale can effectively monitor the severity of pain before and after treatments. Patients can describe the intensity of their pain using descriptors ranging from 'no pain' to 'unbearable pain'. Jensen et al (1989) also supports this assessment method and suggests it is particularly useful for postoperative pain. Therefore, Irene will be assessed using this scale.

According to Alexander et Al (1994), it is recommended that patients in hospitals be provided with pain journals to assess their pain levels and the effectiveness of pain relief. This approach can empower patients and enhance their ability to manage their discomfort. Heath (1995) further states that for Irene, the first step towards pain relief would be the administration of a prescribed analgesic medication. It is also emphasized that nurses should possess knowledge about available pain-relieving medications as well as their potential side effects, enabling them to administer the correct dosage.

According to Mallett and Dougherty (2000), nurses often need to select the most suitable method of pain relief for patients. Patient Controlled Analgesia (Pca) has been found to be an effective and safe technique for administering analgesics for both cancer and postoperative pain. With Pca, Irene would have the ability to

self-administer an analgesic through an infusion pump during episodes of pain. Alexander et al (1994) also endorse this approach to pain relief, stating that patients who used Pca experienced reduced pain levels and were discharged from the hospital early. Evaluating the effectiveness of the administered analgesic is crucial as the doctor may need to adjust the dosage accordingly. According to Clum et al. (1982), complementary methods of pain relief, like massage, should be utilized alongside analgesia.

According to Alexander et al. (1994), there are several methods that can be used to reduce muscle tension and pain after surgery, including deep breathing, cold and heat applications, distraction, and visualization.

Mallett and Dougherty (2000) propose that comfort can be improved by implementing simple measures like proper body positioning and using soft, healing mattresses. These techniques would also be applied to Irene to ensure her post-surgery comfort. Additionally, Irene may potentially develop lymphoedema, a chronic condition characterized by swelling caused by an excessive buildup of lymph fluid in the tissues. This swelling often occurs due to inadequate lymph drainage.

According to Davis et Al. (1997), the most common form of lymphedema affects the limbs and can be caused by either an underdeveloped lymphatic system (primary) or damage from surgery (secondary) (Walsh, 1997).

(2001) Patients who undergo chest cancer interventions with alar clearance have a higher chance of experiencing complications like restricted shoulder mobility and pain. Consequently, the existence of lymphoedema can worsen Irene's postoperative pain, making it essential to prioritize prevention of this condition. Now that Irene has been identified as a high-risk patient for developing lymphoedema, she will receive information about the aforementioned facts concerning this condition prior to her

surgery. It is also vital for Irene to comprehend the three stages of lymphoedema - mild, moderate, and severe.

It is important to reassure her about the interventions that can help reduce her anxiety and educate her on the importance of taking action to prevent this condition, as managing it can be challenging (Davis, 2001). Walsh (1997) suggests recommending self-care and encouraging the patient to monitor for signs of infection, as it can trigger the condition and lead to swelling.

According to Penzer (2003), it is suggested that at this time, a referral should be made to a physical therapist to discuss exercises with Irene that could help prevent the issue from occurring. It is also important to communicate with the patient's family to reduce their anxieties. To facilitate this, they would be encouraged to contact the Lymphoedema Support Network (1999) (cited in Penzer 2003). Mallett and Dougherty emphasize the importance of conducting a comprehensive and accurate assessment of the patient before treatment can begin.

According to Price et Al (1997), it is recommended that nurses measure the circumference of both arms before surgery as a baseline assessment. This will allow for postoperative comparisons to be made. Price et Al (1997) further state that upon Irene's return to the ward after surgery, this should be done.

A further assessment needs to be conducted to determine limb volume by measuring its circumference. Additionally, the skin on the affected side should be examined for signs of infection. After Irene's surgery, postoperative nursing interventions will be implemented to prevent the risk of lymphedema. According to Phipps et al. (1995), proper bed positioning is crucial, with elevation recommended to facilitate wound drainage. At

night, the arm should be supported and raised on a pillow above the heart to encourage lymph drainage.

Throughout the day, it is important to rest the arm and have attentive staff gently lift it while transporting the patient to prevent tension on the wound. The patient should be encouraged to perform gentle exercises starting the day after surgery. The exercises should gradually increase in intensity and frequency as the drainage from the wound decreases (Walsh, 1997).

This should involve movements of the arm, wrist, and elbow to improve blood circulation and lymph drainage. It is important to explain to Irene the significance of these exercises as they can significantly reduce the risk of lymphedema (Price et al. 1997). Another strategy, according to Penzer (2003), is daily skin care. It is recommended that Irene wash and dry the affected arm or side carefully to remove any bacteria that may cause infection. Applying topical creams will help Irene maintain the integrity of her skin.

It is important to encourage the wearing of loose clothing on the affected side and to avoid wearing any jewelry that may hinder lymphatic flow (Price et al.1997). Additionally, manual lymph drainage should be encouraged, which can be achieved through self-massage and helps to redirect lymph fluid back into the main vessels. Manual lymph drainage has been found to significantly reduce lymphedema in the shoulder and back (Davis. 2001).

According to Mallett and Dougherty (2000), if mild lymphoedema occurs on the affected side, it is recommended to apply a properly fitted compression arm. This will assist in fluid drainage and prevent fluid buildup in the tissues. In cases of worsening lymphoedema, Irene would also receive compression

bandaging, which involves wrapping the affected limb in a low-stretch dressing.

According to Davis (2001), nurses and other healthcare professionals can assist by refraining from performing medical procedures that could cause minor injury to the affected arm, such as taking blood pressure, blood samples, and giving injections. As a result, a care plan has been developed for Irene that addresses her post-operative needs. Pain and lymphedema have been identified as high priorities of care for Irene following her breast cancer surgery, so nursing interventions regarding the management of these issues have been implemented.

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