Академический Документы
Профессиональный Документы
Культура Документы
Radical
Mastectomy
(MRM)
Types of Mastectomy
• The usual type of operation for breast
cancer in the Philippines is the modified
radical mastectomy or MRM. The entire
breast is removed, together with the nodes
in armpit.
• However, when breast cancer is detected early,
the entire breast does not have to be removed.
This is called Breast Conserving Therapy or
BCT.
– An adequate margin is obtained around the
cancerous tissue, then the wound is closed, as seen
below the right nipple.
– Then the lymph nodes in the armpit are removed. The
breast is still intact after the removal of the cancerous
tissue.
– Around a month after operation, the patient has to
undergo radiation to the breast.
CONTENTS:
• Demographics/ Incidence (Breast Ca)
• Purposes of MRM
• Diagnosis/ Preparation
• Overview of MRM
• Aftercare
• Risks of MRM
DEMOGRPHICS/ INCIDENCE
• Highest rates of breast cancer occur in
Western countries (>100 cases per
100,000 women);
• and the lowest among Asian countries
(10–15 cases per 100,000 women)
• Men can also have breast cancer, but the
incidence is much less when compared to
women.
DEMOGRPHICS/ INCIDENCE
• Predisposing Factors (Breast Ca):
1. Genetic correlation (history of breast Ca)
2. Females who never breastfed a baby
3. had a child after age 30
4. started menstrual periods very early, or
experienced menopause very late
• Breast cancer is a worldwide public
health problem since there are
approximately one million new cases
diagnosed annually.
GO BACK TO
CONTENTS
PURPOSES OF MRM
1.) Removal of breast cancer (abnormal
cells in the breast that grow rapidly and
replace normal healthy tissue)
– This procedure leaves a chest muscle called
the pectoralis major intact.
– This sparing of the pectoralis major muscle
will avoid a disfiguring hollow defect below the
clavicle.
PURPOSES OF MRM
2.) Allow for the option of breast
reconstruction, a procedure that is
possible, if desired, due to intact muscles
around the shoulder of the affected side.
3.) Involves removal of large multiple tumor
growths located underneath the nipple and
cancer cells on the breast margins
GO BACK TO
CONTENTS
DIAGNOSIS/ PREPARATION
• Modified radical mastectomy is a surgical
procedure to treat breast cancer.
• There are no real alternatives to
mastectomy.
• MRM is one of the standard treatment
recommendations for stage III breast
cancer.
DIAGNOSIS/ PREPARATION
• In order for this procedure to be an
operable option, a definitive diagnosis of
breast cancer must be established.
1.) The first clinical sign for approximately
80% of women with breast cancer is a
mass (lump) located in the breast. (A lump
can be discovered by monthly self-examination or by a
health professional).
DIAGNOSIS/ PREPARATION
Normal results
If no complications develop, the surgical
area should completely heal within three
to four weeks.
OVERVIEW OF MRM
After MRM
OVERVIEW OF MRM
After mastectomy, some women may
undergo breast reconstruction (which can
be done during mastectomy). Recent
studies have indicated that women who
desire cosmetic reconstructive surgery
have a higher quality of life and better
sense of well-being than those who do not
utilize this option.
OVERVIEW OF MRM
INTRAOPERATIVE (Nsg Responsibilities)
Certified registered nurse anesthetist/
Anesthetiologist
administers anesthetic drugs to induce
and maintain anesthesia
administers other medications as
indicated to support the patient's
physical status during surgery
OVERVIEW OF MRM
Circulating nurse
1. sets up the operating room
• ensures that necessary supplies and equipment are
readily available, safe and functional
• makes up the operating room bed with gel and heating
pads
2. greets the patient
3. assists the operating room team in transferring
the client onto the operating room bed
4. positions the patient on the operating room bed
5. performs the surgical skin preparation
OVERVIEW OF MRM
6. opens and dispenses sterile supplies during surgery
7. manages catheters, tubes, drains and specimens
8. assesses the amount of urine and blood loss and reports
these findings to the surgeon and anesthesia
personnel
9. maintains a safe, aseptic environment
– monitors traffic in the operating room
– ensures that the surgical team maintains sterile technique and a
sterile field
10. notes length of surgery
11. performs "sharps", sponge, and instrument count
12. documents all care, events, findings, and patient's
responses during surgery
OVERVIEW OF MRM
Scrub Nurse
1. Helps set up the sterile field
2. Helps assist draping the client
3. Anticipate and hand instruments to the
surgeon
GO BACK TO
CONTENTS
AFTERCARE
• After breast cancer surgery, women
should undergo frequent testing to ensure
early detection of cancer recurrence.
• It is recommended that annual
mammograms, physical examination, or
additional tests (biopsy) be performed
annually.
• Also include psychotherapy since
mastectomy is emotionally traumatic.
AFTERCARE
• Affected women may be worried or have
concerns about appearance, the
relationship with their sexual partner, and
possible physical limitations.
– Community-centered support groups usually
made up of former breast cancer surgery
patients can be a source of emotional support
after surgery.
AFTERCARE
• Surgeon will prescribe medication to
prevent pain. (PRN)
• Fatigue is to be expected following the
surgery.
Nursing Responsibility:
Encourage patients to plan a lighter schedule,
with the possibility of daily naps
AFTERCARE
POSTOPERATIVE (Nsg. Responsibilities)
1.) Watch out for complications of general
anesthesia (see RISKS)
AFTERCARE
2. Nursing Interventions in a post-op mrm
a. Respiratory status
Interventions:
» encourage patient to perform
respiratory exercises
» encourage early ambulation
» assist patients who are restricted to
bed to turn every 1 to 2 hours
» suction as necessary
AFTERCARE
b. circulatory status
Interventions:
– encourage patient to perform leg
exercises
– apply leg procedures
– encourage early ambulation
– position patient in bed so that blood
supply is not interrupted to extremities
– administer anticoagulants as ordered
– promote adequate fluid intake
AFTERCARE
c. Gastrointestinal status
Interventions:
– assist patient to assume a normal
position during defecation
– progress diet as ordered and tolerated
– encourage early ambulation
– promote adequate fluid intake
– administer fiber supplements, stool
softeners, enemas, rectal
suppositories, and rectal tubes as
ordered
AFTERCARE
d. Urinary status
Interventions:
– assist patient to assume normal
position during voiding
– check the patient frequently to
determine need to void
– monitor I & O
AFTERCARE
e. Wound status
Interventions:
– change dressings as ordered utilizing
aseptic technique
g. Comfort
Interventions:
– administer pain medications as ordered
(especially for the first 24-48 hours)
GO BACK TO
CONTENTS
RISKS
• The procedure is performed under general
anesthesia, which itself carries risk.
1.) edema, or swelling of the arm (usually mild)
2.) numbness in the arm or difficulty moving
shoulder muscles. (due to damaged nerve)
3.) risk of developing a lump scar (keloid) after
surgery
4.) If surgery did not remove all the cancer cells
and that further treatment may be necessary
(with chemotherapy and/or radiotherapy)
RISKS
5. worst risk is recurrence of cancer
• Immediate signs of risk following surgery
include:
– fever,
– redness in the incision area,
– unusual drainage from the incision, and
– increasing pain
Nursing Responsibility:
If any of these signs develop, call the surgeon
immediately
GO BACK TO
CONTENTS