emotionally therapeutic because they aid in restoring arm function and provide a sense
of normalcy for the patient.
The patient is instructed about postoperative activity limitation. Generally, heavy lifting
(more than 5 to 10 lbs) is avoided for about 4 to 6 weeks, although normal household
and work-related activities are promoted to maintain muscle tone. Brisk walking, use of
stationary bikes and stepping machines, and stretching exercises may begin as soon as
the patient feels comfortable. Once the drain is removed, the patient may begin to drive
if she has full arm range of motion and is no longer taking opioid analgesics. General
guidelines for activity focus on the gradual introduction of previous activities (e.g.,
bowling, weight-training) once fully healed, although checking with the physician or
nurse beforehand is recommended.
Continuing Care
Patients who have difficulty managing their postoperative care at home may benefit
from a home health care referral. The home care nurse assesses the patient's incision
and surgical drain(s), adequacy of pain management, adherence to the exercise plan,
and overall physical and psychological functioning. In addition, the home care nurse
reinforces previous teaching and communicates important physiologic findings and
psychosocial issues to the patient's primary care provider, nurse, or surgeon.
The frequency of follow-up visits after surgery may vary but generally should occur
every 3 to 6 months for the first several years. The patient may alternate visits with the
surgeon, medical oncologist, or radiation oncologist, depending on the treatment
regimen. The ambulatory care nurse can also be a great source of comfort and security
for the patient and family and should encourage them to telephone if they have any
questions or concerns. It is common for people to ignore routine health care when a
major health issue arises, so women who have been treated for breast cancer should be
reminded of the importance of participating in routine health screening.
Evaluation
Expected Preoperative Patient Outcomes
Expected preoperative patient outcomes may include:
Exhibits knowledge about diagnosis and surgical treatment options
o Asks relevant questions about diagnosis and available surgical
treatments
o States rationale for surgery
o Describes advantages and disadvantages of treatment options
Verbalizes willingness to deal with anxiety and fears related to the diagnosis
and the effects of surgery on self-image and sexual functioning
Demonstrates ability to cope with diagnosis and treatment
o Verbalizes feelings appropriately and recognizes normalcy of mood
lability
o Proceeds with treatment in timely fashion
o Discusses impact of diagnosis and treatment on family and work
Demonstrates ability to make decisions regarding treatment options in timely
fashionExpected Postoperative Patient Outcomes
Expected postoperative patient outcomes may include:
Reports that pain has decreased and states pain and discomfort management
strategies are effective