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Mastectomy is the surgical removal of the breast or part of the breast due
to localized breast cancer. In the case presentation, Mrs. Sara X has been
diagnosed with second stage cancer and the treatment for this cancer is a radical
mastectomy. Radical mastectomy is a ³standard form of mastectomy surgery
that involves the removal of the whole breast, some fa tty tissues, and dissection
of axillaries lymph nodes´. (Monaham & Neighbours, 2003, p 1800).

Mrs. Sara X. is a 53-year-old Fijian female. She has been married with
two children. Since it is a case of breast cancer, health history has to be taken
from all perspective. Generally, Mrs. X has not had any previous illness and it
has been her first time to be admitted to the hospital. She was slightly obese.
Her gynecological history has to be taken since breast is part of the female
reproductive system and some of the occurrence such as time of menarche can
be a contributing factor for breast cancer. She had her menarche at 12 years of
age and she is in post-menopausal stage. Her first child was at the age or 30.
She was also taking the oral contraceptive that can also be the cause of breast
cancer. Her family history also indicated that her maternal side had women been
diagnosed with breast cancer.

She was admitted to the hospital after lumps were detected during a
physical examination and a mammography done to confirm breast cancer.
Mammography is a radiologic study of the breast used to evaluate differences in
the density of tissue, particularly small or poorly defined masses or nodules.
The subjective data is the information that is obtained from the patient. For Mrs.
X it has been the feeling the presence of lumps, fever, discomfort, and nipple
discharge. On the other hand, objective data is based on inspection and
palpation of the breast. Vital signs are also very important as it provides the
baseline reading. Inspection considers the breast, nipple, areola, the color,
texture, venous pattern on skin, retraction of nipples, dimpling of breasts and
the axillaries. Palpation is done on the breast to feel for lumps, masses and
thickenings. It is very important to document these findings.

Since Mrs. X is undergoing mastectomy, it becomes important for the

nurses to provide a preoperative care that fully prepares her for the surgery and
into the postoperative phase. Preoperative phase includes getting an informed
consent for surgery, taking the vital signs, keeping the patient nil by mouth for
6-8 hours, infusing ordered IV fluids and maintaining a patent IV line, shaving
of the area concerned, adequate rest, elimination and removing all the physical
contents such as nail polish or dentures. Most important of all, Mrs. X was
explained what she is going to expect after the surgery, breathin g and coughing
exercises, and immobilization of the affected arms and hands. Emotional
support is very important so that Mrs. X would not be anxious. Before the
patient is handed to the OT nurse, the checklist has to fill to ensure accuracy.

Postoperative care prepares the patient for discharge and recovery.

Firstly, the wound has to be properly dressed with sterile technique. The patient
has to be taught about the medicines, care of the wound, diet, and re visits to the
hospital for checkups. Emotional support is important since mastectomy can
result in low self-esteem. Mrs. X had to be taught about the breast
reconstruction or prosthesis for the affected side.

During Mrs. Xs admittance to the hospital, the nursing care plan had
been formulated. The fore most diagnosis was anxiety, which was obvious
through expression and the elevated blood pressure. The management for it was
to provide emotional support and explain the procedure and what to expect after
the surgery. Mrs. X was allowed to ask questions to clear her doubts. Secondly,
the there was a risk for inadequate coping related to cancer and body image. To
solve this, an open and therapeutic relationship had to be maintained with the
patient so that she felt comfortable with discussing things. Thirdly, there was
pain related to the surgery. In order to relieve pain, analgesics was administered
to the patient according to the doctor¶s orders, providing support to the affected
side and elevating the arms on the affected side. Involvement of the
physiotherapist is also required to alleviate pain. After the interventions, the
patient was free of pain and she was comfortable in her bed. Mrs. X also had an
understanding of what procedures was going to occur during the peri-poperative
phase.

Mastectomy is a traumatic and life changing surgery. The patients have to

go through a lot in terms of reduced self-esteem and affected social life and
sexuality. Therefore, as nurses it becomes important to know how to properly
take care of such patients. Emotional support and family and patient education
is very important and the patients can be educated about the organizations such
as Fiji Cancer Society for support and high morale and a normal life for them.

(approx: 840 words)