Introduction

A mastectomy, the surgical removal of one or both breasts, is a significant and often emotionally charged procedure performed for various reasons, including breast cancer treatment or risk reduction. The nursing management of a patient undergoing a mastectomy is crucial for addressing physical and emotional needs, promoting recovery, and supporting the patient’s overall well-being. This comprehensive guide outlines key nursing considerations at each stage of the mastectomy process.

Preoperative Nursing Management:

A. Nursing Assessment:

1. Comprehensive Health Assessment:
   • Conduct a thorough health assessment, focusing on the patient’s breast health, cancer diagnosis, and any comorbid conditions.
   • Assess the patient’s emotional state and coping mechanisms related to the impending surgery.
2. Psychosocial Assessment:
   • Evaluate the patient’s emotional well-being, addressing concerns about body image, self-esteem, and potential anxiety.
   • Identify support systems and coping strategies in place.
3. Baseline Vital Signs:
   • Obtain baseline vital signs, including blood pressure, heart rate, respiratory rate, and temperature.
   • Assess for any deviations from normal values that may require preoperative intervention.

B. Preoperative Education:

1. Procedure Explanation:
   • Provide detailed information about the mastectomy procedure, its purpose, potential risks, and expected outcomes.
   • Address any misconceptions and ensure the patient has realistic expectations.
2. Preoperative Instructions:
   • Instruct the patient on preoperative preparations, including fasting guidelines, medication restrictions, and hygiene practices.
   • Clarify any specific preoperative tests or imaging required.
3. Postoperative Expectations:
   • Educate the patient on postoperative care, including wound care, drain management, and potential sensations or discomfort.
   • Discuss the importance of adhering to postoperative follow-up appointments.

C. Informed Consent:

1. Consent Process:
   • Ensure the patient fully understands the mastectomy procedure, associated risks, and alternatives before obtaining informed consent.
   • Verify that the consent form is signed and witnessed according to institutional protocols.
2. Documenting Consent:
   • Document the informed consent process in the patient’s medical record, including any specific concerns or questions addressed.

Intraoperative Nursing Management:

A. Preoperative Preparation:

1. Preoperative Checklist:
   • Collaborate with the surgical team to complete a preoperative checklist, ensuring all necessary preparations are in place.
   • Verify patient identification, surgical site, and the correct procedure using established protocols.
2. Preoperative Medications:
   • Administer preoperative medications as prescribed, including anesthesia induction agents and antibiotics.
   • Monitor the patient’s response to medications and report any adverse reactions to the anesthesia provider.

B. Intraoperative Monitoring:

1. Vital Signs Monitoring:
   • Continuously monitor vital signs throughout the surgery, including blood pressure, heart rate, respiratory rate, and oxygen saturation.
   • Report any significant changes promptly to the anesthesia provider and surgical team.
2. Blood Loss Monitoring:
   • Monitor blood loss during the mastectomy procedure and communicate with the surgical team about any significant bleeding.
   • Prepare for potential blood transfusions according to institutional protocols.
3. Positioning:
   • Ensure the patient is positioned correctly on the operating table to provide optimal access for the surgical team.
   • Use pressure-relieving devices and padding to prevent intraoperative complications such as pressure ulcers.

Postoperative Nursing Management:

A. Immediate Postoperative Care:

1. Recovery Room Care:
   • Transfer the patient to the recovery room and closely monitor vital signs.
   • Assess for emergence from anesthesia, pain levels, and any signs of postoperative complications.
2. Pain Management:
   • Implement the prescribed pain management plan, including analgesics and any patient-controlled analgesia (PCA) devices.
   • Use a pain assessment scale to evaluate pain intensity and adjust interventions accordingly.
3. Fluid and Electrolyte Balance:
   • Monitor fluid intake and output to assess the patient’s hydration status.
   • Address any imbalances promptly and collaborate with the healthcare team for interventions.

B. Postoperative Education:

1. Wound Care Instructions:
   • Provide detailed instructions on caring for the surgical incision, including hygiene, dressing changes, and signs of infection.
   • Emphasize the importance of reporting any unusual symptoms promptly.
2. Drain Management:
   • Educate the patient on the purpose and care of drains, if used, including emptying and recording drain output.
   • Discuss the potential duration of drain usage and when drains will be removed.
3. Activity and Mobility:
   • Instruct the patient on postoperative activity restrictions, gradual resumption of normal activities, and proper arm exercises.
   • Encourage early ambulation to prevent complications such as deep vein thrombosis.

C. Complications Monitoring:

1. Monitoring Vital Signs:
   • Continue monitoring vital signs regularly in the postoperative period to detect any signs of complications.
   • Collaborate with the healthcare team to address any abnormal findings promptly.
2. Pain and Comfort:
   • Assess pain levels regularly and adjust pain management interventions as needed.
   • Be vigilant for signs of infection, hematoma formation, or other complications related to the surgical site.
3. Psychosocial Support:
   • Offer emotional support to address any emotional or psychological responses to the surgery.
   • Facilitate open communication and provide resources for counseling or support groups if needed.

Discharge Planning and Follow-up:

A. Discharge Education:

1. Wound Care and Follow-up:
   • Reinforce wound care instructions and schedule follow-up appointments for wound assessment and removal of sutures.
   • Provide contact information for any questions or concerns that may arise after discharge.
2. Drain Removal Instructions:
   • Educate the patient on the criteria for drain removal and provide instructions on what to expect during the removal process.
   • Discuss signs of potential complications after drain removal.
3. Emotional Well-being:
   • Address the patient’s emotional well-being, acknowledging potential concerns related to body image, self-esteem, and postoperative adjustment.
   • Provide information on support groups and resources for continued psychosocial support.

B. Long-term Follow-up and Survivorship:

1. Ongoing Surveillance:
   • Emphasize the importance of regular follow-up appointments and surveillance for any signs of cancer recurrence or complications.
   • Collaborate with oncologists and other healthcare providers to ensure comprehensive care.
2. Breast Reconstruction Considerations:
   • Discuss breast reconstruction options with the patient, if applicable, and provide resources for consultations with reconstructive surgeons.
   • Offer information on timing and potential complications of breast reconstruction.
3. Patient Advocacy:
   • Advocate for the patient’s needs and concerns, facilitating communication with the healthcare team.
   • Encourage ongoing patient engagement in survivorship care planning and decision-making.