48 - 7). The patient is instructed to follow these guidelines for the rest of her life. She is
also instructed to contact the physician or a nurse immediately if she suspects that she
has lymphedema, because early intervention provides the best chance for control. If
allowed to progress without treatment, the swelling can become more difficult to
manage. Treatment may consist of a course of antibiotics if an infection is present. A
referral to a rehabilitation specialist (e.g., occupational or physical therapist) may be
necessary for a compression sleeve and/or glove, exercises, manual lymph drainage,
and a discussion of ways to modify daily activities to avoid worsening lymphedema.
Hematoma or Seroma Formation
Hematoma formation (collection of blood inside the cavity) may occur after either
mastectomy or breast conservation and usually develops within the first 12 hours after
surgery. The nurse assesses for signs and symptoms of a hematoma at the surgical site,
which may include swelling, tightness, pain, and bruising of the skin. The surgeon
should be notified immediately for gross swelling or increased bloody output from the
drain. Depending on the surgeon's assessment, a compression wrap may be applied to
the incision for approximately 12 hours, or the patient may be returned to the operating
room so that the incision may be reopened to identify the source of bleeding. Some
hematomas are small, and the body absorbs the blood naturally. The patient may take
warm showers or apply warm compresses to help increase the absorption. A hematoma
usually resolves in 4 to 5 weeks.
A seroma, a collection of serous fluid, may accumulate under the breast incision after
mastectomy or breast conservation or in the axilla. Signs and symptoms may include
swelling, heaviness, discomfort, and a sloshing of fluid. Seromas may develop
temporarily after the drain is removed or if the drain is in place and becomes
obstructed. Seromas rarely pose a threat and may be treated by unclogging the drain or
manually aspirating the fluid with a needle and syringe. Large, long-standing seromas
that have not been aspirated could lead to infection. Small seromas that are not
bothersome to the patient usually resolve on their own.
Hand and Arm Care After Axillary Lymph Node Dissection
Avoid blood pressures, injections, and blood draws in affected extremity.
Use sunscreen (higher than 15 SPF) for extended exposure to sun.
Apply insect repellent to avoid insect bites.
Wear gloves for gardening.
Use cooking mitt for removing objects from oven.
Avoid cutting cuticles; push them back during manicures.
Use electric razor for shaving armpit.
Avoid lifting objects greater than 5–10 pounds.
If a trauma or break in the skin occurs, wash the area with soap and water, and
apply an over-the-counter antibacterial ointment (Bacitracin or Neosporin).
Observe the area and extremity for 24 hours; if redness, swelling, or a fever
occurs, call the surgeon or nurse.Infection
Although infection is rare, it is a risk after any surgical procedure. This risk may be
higher in patients with accompanying conditions such as diabetes, immune disorders,
and advanced age, as well as in those with poor hygiene. Patients are taught to monitor
for signs and symptoms of infection (redness, warmth around incision, tenderness, foul-
smelling drainage, temperature greater than 100.4°F, chills) and to contact the surgeon