Medical Surgical Nursing

Questions such as these can help the patient focus. Once the patient's decision is made,
it is very important to support it.
Postoperative Nursing Interventions
Relieving Pain and Discomfort
Many patients tolerate the breast surgery quite well and have minimal pain during the
postoperative period. This is particularly true of the less invasive procedures such as
breast conservation treatment with SLNB. However, all patients must be carefully
assessed, because individual patients can have varying degrees of pain. Patients who
have had more invasive procedures such as a modified radical mastectomy with
immediate reconstruction may have considerably more pain. All patients are discharged
home with analgesic medication (e.g., oxycodone and acetaminophen [Percocet] or
propoxyphene and acetaminophen [Darvocet]) and are encouraged to take it if needed.
An over-the-counter analgesic such as acetaminophen may provide sufficient relief.
Sometimes patients complain of a slight increase in pain after the first few days of
surgery; this may occur as patients regain sensation around the surgical site and become
more active. However, patients who report excruciating pain must be evaluated to rule
out any potential complications such as infection or a hematoma. Alternative methods
of pain management such as taking warm showers and using distraction methods (eg,
guided imagery) may also be helpful.
Managing Postoperative Sensations
Because nerves in the skin and axilla are often cut or injured during breast surgery,
patients experience a variety of sensations. Common sensations include tenderness,
soreness, numbness, tightness, pulling, and twinges. These sensations may occur along
the chest wall, in the axilla, and along the inside aspect of the upper arm. After
mastectomy, some patients experience phantom sensations and report a feeling that the
breast and/or nipple are still present. Overall, patients do not find these sensations
severe or distressing (Baron et al., 2004). Sensations usually persist for several months
and then begin to diminish, although some may persist for as long as 2 years and
possibly longer. Patients should be reassured that this is a normal part of healing and
that these sensations are not indicative of a problem.
Promoting Positive Body Image
Patients who have undergone mastectomy often find it very difficult to view the
surgical site for the first time. No matter how prepared the patient may think she is, the
appearance of an absent breast can be very emotionally distressing. Some patients who
have undergone breast conservation treatment may find it difficult to view their
surgical incisions, although this is rare. Ideally, the patient sees the incision for the first
time when she is with the nurse or another health care provider who is available for
support.
The nurse first assesses the patient's readiness and provides gentle encouragement. It is
important to maintain a patient's privacy while assisting her as she views the incision;
this allows her to express feelings safely to the nurse. Asking the patient what she
perceives, acknowledging her feelings, and allowing her to express her emotions are
important nursing actions. Reassuring the patient that her feelings are a normal
response to breast cancer surgery may be comforting. If the patient has not had
immediate reconstruction, providing her with a temporary breast form to place in her
bra on discharge can help alleviate feelings of embarrassment or self-consciousness.
Promoting Positive Adjustment and Coping
Providing ongoing assessment of how the patient is coping with her diagnosis of breast
cancer and her surgical treatment is important in determining her overall adjustment.
Assisting the patient in identifying and mobilizing her support systems can be
beneficial to her well-being. The patient's spouse or partner may need guidance,