Planning and Goals
The major goals may include increased knowledge about the disease and its treatment;
reduction of preoperative and postoperative fear, anxiety, and emotional stress;
improvement of decision-making ability; pain management; improvement in coping
abilities; improvement in sexual function; and the absence of complications.
Preoperative Nursing Interventions
Providing Education and Preparation About Surgical Treatments
Patients with newly diagnosed breast cancer are expected to absorb an abundance of
new information during a very emotionally difficult time. The nurse plays a key role in
reviewing treatment options by reinforcing information provided to the patient and
answering any questions. The nurse fully prepares the patient for what to expect before,
during, and after surgery. Patients undergoing breast conservation with ALND, or a
total or modified radical mastectomy, generally remain in the hospital overnight (or
longer if they have immediate reconstruction). Surgical drains will be inserted in the
mastectomy incision and in the axilla if the patient undergoes an ALND. A surgical
drain is generally not needed after a SLNB. The patient should be informed that she
will go home with the drain(s) and that complete instructions about drain care will be
provided prior to discharge. In addition, the patient should be informed that she will
often have decreased arm and shoulder mobility after an ALND and that she will be
shown range-of-motion exercises prior to discharge. The patient should also be
reassured that appropriate analgesia and comfort measures will be provided to alleviate
any postoperative discomfort.
Reducing Fear and Anxiety and Improving Coping Ability
The nurse must help the patient cope with the physical as well as the emotional effects
of surgery. Many fears may emerge during the preoperative phase. These can include
fear of pain, mutilation (after mastectomy), and loss of sexual attractiveness; concern
about inability to care for oneself and one's family; concern about taking time off from
work; and coping with an uncertain future. Providing the patient with realistic
expectations about the healing process and expected recovery can help alleviate fears.
Maintaining open communication and assuring the patient that she can contact the
nurse at any time with questions or concerns can be a source of comfort. The patient
should also be made aware of available resources at the treatment facility as well as in
the breast cancer community such as social workers, psychiatrists, and support groups.
Some women find it helpful and reassuring to talk to a breast cancer survivor who has
undergone similar treatments.
Promoting Decision-Making Ability
The patient may be eligible for more than one therapeutic approach; she may be
presented with treatment options and then asked to make a choice. This can be very
frightening for some patients, and they may prefer to have someone else make the
decision for them (e.g., surgeon, family member). The nurse can be instrumental in
ensuring that the patient and family members truly understand their options. The nurse
can then help the patient weigh the risks and benefits of each option. The patient may
be presented with the option of having breast conservation treatment followed by
radiation or a mastectomy. The nurse can explore the issues with the individual patient
by asking questions such as the following:
How would you feel about losing your breast?
Are you considering breast reconstruction?
If you choose to retain your breast, would you consider undergoing radiation
treatments 5 days a week for 5 to 6 weeks?