Breast cancer can affect one or both breasts and is usually found through an exam or mammogram and then diagnosed through a biopsy to determine if cells are malignant.
The stage of the breast cancer determines the prognosis and treatment options. Breast cancer stages range from 0 to IV. Stage IV breast cancer means it has spread to other areas of the body and carries a poor prognosis.
While breast cancer occurs mostly in women, men can get breast cancer as well. The majority of breast cancer occurs in women who are 50 years of age or older.
Nursing Process
Nurses can expect to encounter patients with breast cancer in a variety of settings. Women are routinely assessed for breast cancer and nurses may be involved in performing mammograms. Once diagnosed, nurses will have roles in the patient’s treatment including both outpatient and in the hospital. Nurses provide support and education to their patients before, during, and after treatment for breast cancer.
Nursing Assessment
Nursing assessment in breast cancer involves a thorough evaluation of the patient’s physical, emotional, and psychosocial needs. This comprehensive assessment is essential for developing an individualized care plan.
Nursing Intervention
Nursing interventions in breast cancer care encompass a range of activities aimed at managing symptoms, providing education, and offering emotional support throughout the treatment journey.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for breast cancer, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for breast cancer.
Acute Pain
Pain associated with breast cancer can be caused by tissue damage from the cancer. It can also be caused by the treatment measures used to fight the cancer.
Nursing Diagnosis: Acute Pain
Related to:
- Tumor advancement causing inflammation and compression on nerves and bones
- Chemotherapy
- Radiation
- Surgery
As evidenced by:
- Verbalization of pain
- Body language/guarding behavior
- Facial grimacing
- Changes in vital signs
- Agitation/restlessness
Expected Outcomes:
- Patient will verbalize pain is reduced or controlled
- Patient will demonstrate the ability to perform ADLs due to improved comfort
Assessment:
1. Assess pain appropriately.
Breast cancer can cause pain due to the tumor(s) or from the cancer treatments. The nurse can assess pain by asking the patient their pain level on a 0-10 scale or using a nonverbal pain scale if the patient is unable to rate.
2. Assess pain with vital signs.
Elevated blood pressure, tachycardia, and tachypnea are often seen along with complaints of pain. The nurse can assess if pain is controlled or not by assessing for changes in vital signs. Of course, pain is always subjective and the nurse will treat for pain based on the patient’s report.
3. Examine the patient’s cultural norms regarding pain expression.
Some cultures display pain openly, while others do not. The nurse can address this by assessing for pain often, using verbal and nonverbal pain scales, and remaining understanding and nonjudgmental towards the patient’s beliefs.
Interventions:
1. Administer pain medication as prescribed.
Patients being treated for breast cancer often require a combination of opioids and NSAIDs along with antiemetics for nausea caused by chemotherapy to relieve pain and discomfort.
2. Evaluate the effectiveness of pain medication.
After pain medications are administered, evaluate the effectiveness regularly. The dosage and type of medications may need to be adjusted by the physician if the patient’s pain is not controlled.
3. Provide nonpharmacological pain management.
Participating in activities such as distraction, massage, hot/cold compresses, and acupuncture may provide the patient with pain relief and relaxation.
4. Educate patients about side effects and treatment.
Inform the patient about what to expect regarding side effects of chemotherapy, radiation, and other treatments which are often uncomfortable. Educate and encourage patients to be honest about their pain and communicate regularly with their provider.
Anxiety
Fear and anxiety can be caused by the unknown that comes with a breast cancer diagnosis.
Nursing Diagnosis: Anxiety
Related to:
- Crisis (breast cancer diagnosis)
- Threat of death
- Lack of knowledge
- Unfamiliarity with treatments
- Change in health status
As evidenced by:
- Verbalization of fear or worry
- Distressed appearance: shaking, hand wringing, restlessness
- Insomnia
- Shortness of breath or heart-pounding sensation (acute panic)
- Crying
- Difficulty concentrating
- Lack of appetite
Expected Outcomes:
- Patient will verbalize anxiety is decreased to a manageable level
- Patient will verbalize ways to cope with increasing anxiety/fear
- Patient will demonstrate ways to recognize symptoms of anxiety and fear at the onset to avoid reaching a panic state
Assessment:
1. Assess expressions of fear/anxiety.
Assess the patient’s verbal and nonverbal expressions of fear/anxiety. Inquire about how they are feeling and evaluate nonverbal expressions.
2. Determine the cause of fear/anxiety.
Actively listen to the patient to show them they can be open about what they are feeling and will not be judged or dismissed. Support but do not provide false reassurances.
3. Assess coping strategies.
Assess the patient’s coping strategies in response to their anxiety/fear. Ask questions about what strategies are or aren’t working. Determine if new strategies need to be implemented.
Interventions:
1. Provide a calm environment.
A chaotic or stimulating environment can cause an increase in anxiety. Use a calm and supportive voice when talking with the patient. Patients can pick up on anxiety from the nurse and the surrounding environment.
2. Promote relaxation techniques.
There are a variety of relaxation techniques that may work to help a patient’s anxiety and fear. These include meditation, yoga, deep breathing, guided imagery, and talk therapy. Encourage the patient to try multiple techniques to determine what works best for them.
3. Educate patients on their diagnosis.
The fear of the unknown can come from a lack of information regarding their diagnosis. Evaluate the patient’s understanding of their diagnosis, treatment, and prognosis. Answering questions accurately and addressing misconceptions can ease fear and anxiety.
4. Evaluate support systems.
Determine what kind of support system the patient has. Encourage family support along with support groups. Support groups can include other breast cancer patients, breast cancer survivors, and caregiver groups. Support helps reduce feelings of isolation, which can cause anxiety and fear.
Impaired Skin Integrity
Treatments for breast cancer can affect the patient’s skin integrity causing irritation, pain, and other complications as well as increasing the susceptibility to infection.
Nursing Diagnosis: Impaired Skin Integrity
Related to:
- Effects of radiation
- Effects of chemotherapy
- Surgical incisions
- Lymphedema following surgery or radiation
- Alteration in nutritional status
- Immunocompromised status
As evidenced by:
- Skin irritation: redness, skin peeling, swelling
- Damaged epidermal tissue
Expected Outcomes:
- Patient will remain free of infection from impaired skin integrity
- Patient will alert provider of changes to the skin such as redness/swelling
- Patient will display optimal healing post-mastectomy or lumpectomy without signs of infection
Assessment:
1. Monitor skin during radiation.
Patients undergoing radiation should have the area assessed at each session for redness, skin peeling or blistering and other irritation. These are common with radiation but should be monitored. The patient should also be instructed to closely examine their skin following treatment.
2. Assess surgical incisions.
If the patient had a mastectomy or lumpectomy, they will have surgical incisions and possibly drains. Assess for signs of infection such as erythema, swelling, warmth, and drainage. Note the characteristics and amount of drainage.
3. Assess for lymphedema.
Lymphedema can occur months or years following the removal of lymph nodes which disrupts the lymphatic system and causes painful swelling and damage to the skin. Along with swelling the patient may complain of tightness in the armpit area, clothing not fitting as normal, aching, and weakness.
Interventions:
1. Ensure nutritional needs are met.
Altered nutrition can cause skin breakdown and delayed wound healing. Collaborate with the dietician to ensure the patient is receiving adequate nutrition and is educated on the importance of adequate nutrition.
2. Education on radiation skin care protocol.
If the patient is receiving radiation for their breast cancer treatment, educate them on how radiation can affect their skin integrity. Stress the importance of avoiding lotions, deodorants, and other potentially irritating products.
3. Adhere to limb restrictions.
Lymphedema is a concern following the removal or radiation of axillary lymph nodes. The risk can be decreased by not taking a blood pressure or performing lab draws in the affected arm.
4. Encourage loose clothing.
Encourage patients to wear soft and loose clothing during the months they are receiving chemotherapy and/or radiation therapy. Explain the importance of avoiding friction, tightness, or constriction from the clothing they wear.
Nursing Diagnosis and Rationale for Breast Cancer
1. Acute Pain
Rationale: Pain is a common symptom in breast cancer patients, whether due to the tumor itself, surgical interventions, or side effects of treatments such as chemotherapy and radiation. Nurses should assess the intensity, location, and characteristics of the pain and provide appropriate pain management strategies, including pharmacologic and non-pharmacologic interventions. Educating patients on pain control techniques and encouraging open communication about their pain can help improve their comfort and quality of life.
2. Risk for Infection
Rationale: Breast cancer treatments, particularly chemotherapy, can suppress the immune system, increasing the patient’s risk of infection. Nurses should monitor for signs of infection, educate patients on infection prevention measures, and ensure that patients adhere to recommended vaccinations. Teaching patients about proper wound care post-surgery and the importance of reporting any signs of infection promptly is crucial in preventing complications.
3. Body Image Disturbance
Rationale: Breast cancer and its treatments can significantly impact a patient’s body image and self-esteem. Mastectomy, hair loss, and other physical changes can lead to feelings of loss and altered self-perception. Nurses should provide emotional support, discuss potential changes with the patient before they occur, and offer resources such as counseling or support groups. Encouraging patients to express their feelings and providing information on reconstructive options can help them cope with body image changes.
4. Fear and Anxiety
Rationale: The diagnosis of breast cancer and the uncertainty of outcomes can cause significant fear and anxiety in patients. This anxiety can impact their ability to process information and make decisions about their care. Nurses should provide clear, concise information about the disease, treatment options, and prognosis. Offering emotional support, teaching relaxation techniques, and referring to mental health professionals can help patients manage their anxiety and improve their overall well-being.
5. Knowledge Deficit
Rationale: Patients with breast cancer may lack understanding about their condition, treatment options, and necessary self-care strategies. Nurses should provide comprehensive education tailored to the patient’s needs, including information on the disease process, treatment regimens, potential side effects, and lifestyle modifications. Using teach-back methods and providing written materials can enhance the patient’s understanding and adherence to the treatment plan.
6. Impaired Physical Mobility
Rationale: Surgical interventions, fatigue from treatments, and the physical effects of the tumor can limit a breast cancer patient’s mobility. Nurses should assess the patient’s physical capabilities and develop a plan to promote mobility and prevent complications such as deep vein thrombosis. Collaborating with physical therapists, providing exercises to improve strength and flexibility, and educating patients on energy conservation techniques can support their physical well-being.
7. Nutritional Imbalance: Less Than Body Requirements
Rationale: The side effects of breast cancer treatments, such as nausea, vomiting, and taste changes, can lead to decreased nutritional intake and weight loss. Nurses should assess the patient’s nutritional status, collaborate with dietitians to develop individualized meal plans, and provide strategies to manage treatment-related side effects. Encouraging small, frequent meals and nutritional supplements can help meet the patient’s energy and nutrient needs.
8. Fatigue
Rationale: Fatigue is a prevalent symptom in breast cancer patients, often resulting from the disease itself and its treatments. Nurses should assess the level of fatigue, identify contributing factors, and develop a management plan. Educating patients on energy conservation techniques, promoting regular physical activity, and collaborating with healthcare providers to manage fatigue can improve the patient’s quality of life.
9. Sexual Dysfunction
Rationale: Breast cancer and its treatments can impact a patient’s sexual health, causing changes in sexual desire, body image, and physical ability. Nurses should provide a safe space for patients to discuss their concerns, offer education on potential changes, and refer to specialists such as sex therapists if needed. Providing information on intimacy and sexual health can help patients maintain their relationships and sexual well-being.
10. Risk for Lymphedema
Rationale: Lymphedema, or swelling of the arm, can occur in patients who have undergone lymph node removal or radiation therapy. Nurses should educate patients on recognizing early signs of lymphedema, such as swelling, heaviness, or tightness in the affected arm. Teaching patients’ preventive measures, such as avoiding heavy lifting, practicing good skin care, and performing prescribed exercises, can help reduce the risk of lymphedema.
REFERENCES
- Anxiety. (n.d.). Cancer.Net. https://www.cancer.net/coping-with-cancer/managing-emotions/anxiety
- Breast cancer – Diagnosis and treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/breast-cancer/diagnosis-treatment/drc-20352475
- Breast Cancer: Lymphedema After Treatment. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/breast-cancer-lymphedema-after-treatment
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Leventhal, J., & Young, M. R. Radiation Dermatitis: Recognition, Prevention, and Management. Cancer Network. https://www.cancernetwork.com/view/radiation-dermatitis-recognition-prevention-and-management
- Odhner, M. (n.d.). Nonverbal Pain Scale (NVPS) for Nonverbal Patients. MDCalc. https://www.mdcalc.com/nonverbal-pain-scale-nvps-nonverbal-patients
- Treating Cancer Pain. (n.d.). Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/palliative-care/pain-management/treating-pain
- What Is Breast Cancer? | CDC. (n.d.). Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/basic_info/what-is-breast-cancer.htm
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