Question

M.D. is a 50-year-old woman whose routine mammogram showed a 2.3-×4.5-cm lobulated mass at the 3 o'clock position in her left breast. M.D. underwent a stereotactic needle biopsy and was diagnosed with infiltrating ductal carcinoma, estrogen receptor positive. The staging workup was negative for distantmetastasis. Her final staging was stage IIB. She had a modified radical mastectomy with lymph node dissection. The sentinel lymph node and 4 of 16 lymph nodes were positive for tumor cells. An implanted port was placed during surgery.

1. Surgical intervention is the primary treatment for breast cancer. Describe the surgical
procedure that M.D. had.

2. What actions will you teach M.D. to reduce her risk of developing lymphedema?

3. M.D. asks you why she has to have chemotherapy with so many drugs if the surgeon removed
all of the cancer. How would you respond?

4. The physician orders a 500-mL normal saline bolus now, with orders to infuse over 2 hours.
You decide to use M.D.'s implanted port for intravenous (IV) access. After you access the port
and connect the fluid, the infusion pump alarms that the line is occluded. What will you do?

Answer 1

Ans)1) Modified radical mastectomy, a surgeon removes the breast, including all or some overlying skin, the nipple and areola, most or all of the lymph nodes under the arm, and the lining over the chest muscles. This is a less extensive surgery than a radical mastectomy.

- When treating breast cancer, a doctor’s primary goal is to remove cancerous cells and reduce the risk of cancer spreading while preserving as much breast tissue as possible. Modified radical mastectomy is a way a surgeon achieves this goal.

2) Health teaching to reduce lymphadema:

- Protect your arm or leg. Avoid injury to your affected limb.
- Rest arm or leg while recovering. After cancer treatment, exercise and stretching are encouraged.
- Avoid heat on your arm or leg.
- Elevate your arm or leg.
- Avoid tight clothing.
- Keep your arm or leg clean.

3) Chemotherapy is used after surgery to remove the breast cancer i.e to get rid of any cancer cells that may be left behind and to reduce the risk of the cancer coming back or its reoccurrance.

4) If the implanted port gets occluded then try flushing the catheter with 10ml 0.9% saline. If the fluids still refuse to free-flow, then instil Urokinase into the catheter and leave for 60 minutes. If this fails, repeat the Urokinase instillation but this time leave it in the line for several hours or overnight.