Discharge-plan

SANDE, JEIEL TIMOTHY I. | BSN – 3B

Medical-Surgical Nursing

DISCHARGE PLAN Client’s Initials: DC Diagnosis: Post-operative lumpectomy and sentinel lymph node dissection of 1.5 cm mass in the upper outer quadrant of left breast—breast cancer Probable Date: N/A Destination: N/A Transportation: N/A Medications Drug Name: Ibuprofen Dosage: 400-800 mg 3 to 3 times daily (do not exceed 3200 mg/day) Purpose: Anti-inflammatory Effect: Decreased pain and inflammation. Side effects: Headache, Dizziness, Drowsiness, Constipation Environment  Keep an environment with these things in mind & Exercise  Have a tidy living space to avoid hitting the surgical wound on anything  Keep the living space clean in order to prevent infection  Maintain an emotionally supportive environment with family and friends to promote mental well-being  Create a relaxing home environment to keep stress levels down and promote holistic well-being

Treatments

 Mobility and exercise should support rehabilitation  Avoid physically straining tasks such as lifting heavy objects  Wearing a supportive bra helps to keep the breast secure and supported. Avoid bras that have an underwire, as it may cause discomfort if it rubs against the incision. Soft bras such as lace is recommended.  Avoid any straining movements that might affect the post operation are such as running or lifting.  Complete these arm stretches exercises regularly to help alleviate swelling. When doing these exercises, she must wear clean, comfortable clothes.  Wand Exercise  Elbow Winging  Shoulder Blade Stretch  Shoulder Blade Squeeze  Side Bends  Chest Wall Stretch  Shoulder Stretch  Wearing an arm sleeve or vest may help reduce swelling in the arm or breast area and prevent lymphoedema complications.  Once the wound is healed and the client is physically able, return to normal routine will be possible  Wound care:  Take sponge baths until sutures are removed and wash gently around the incision with mild soap and water. When bandages

get dirty or wet, gently pat down until dry and replace with new, clean bandages.  Regularly heck the incision for pain, discharge, or swelling as these are signs of infection.  Avoid the use of deodorant and anti-perspirants near the incision  Take prescribed ibuprofen as ordered before pain is unbearable.

Health Education

Observable Symptoms

 Swelling management:  If swelling, apply ice on the affected breast (15-20 mins) per hour.  Use the affected surgical arm as much as possible without straining the breast.  Do the arm exercises mentioned above to encourage blood flow.  Avoid pressuring or squeezing the affected area or arm.  Avoid drinking alcohol and smoking.  Wear an elastic sleeve.  Do not massage, compress or bump the surgical area.  Explain the importance of follow-up care and that after the lumpectomy, the medical team will continue to monitor for a recurrence and manage side effects of the treatment. Annual mammograms may be done for monitoring.  Inform the client of long-term effects of the lumpectomy include hardening around the incision area, scarring, and an increased risk of lymphedema in areas surrounding the breast such as the chest or arm.  Teach the client what normal and abnormal post-operative signs and symptoms so that she may be aware of the positive or negative changes that may happen  Teaching the client about the effects of smoking on her body after the recovery and recommending cessation may encourage the stoppage of smoking as it is proven to be harmful to the body.  Help inform the client of healthy habits to replace her old ones The following symptoms can be expected after a lumpectomy:  Fatigue  Anxiety or feeling downtrodden  Mild discomfort for a couple of days  Bruising and mild swelling of the incision area  Tingling  Numbness  Twinges  Constipation may be caused by pain medication. If the following symptoms arise, immediately call your doctor:  Shortness of breath  Warmth around incision  High temperature or chills  Nausea or vomiting  Bleeding from incision  Increased swelling of incision  Increased redness and discomfort of incision  Discharge from incision

Dietary Prescription

Spirituality

1. Drink a sufficient amount of water (6 to 8 glasses). Stay away from overly sweet and caffeinated beverages. 2. Begin with a light diet, preferably easy-to-digest food like in a soft diet. 3. As time progresses, increase the amount of protein and iron to help speed up the wound healing. Particularly iron will help you regain energy by encouraging the production of more blood cells. Foods that are rich in iron and protein are poultry, seafood, nuts, eggs, and beans and lentils. 4. An increase in fiber will with constipation due to pain medications. Food containing fiber includes fruits and vegetables, as well as whole grain and cereals. 5. Avoid drinking alcohol or smoking. The client is encouraged to joining a support group(s) in order to foster a relationship with other people who have gone through similar experiences to promote spiritual, mental, and emotional well-being.

References:

Davis Company. (2015). Ibuprofen [PDF]. Davis Company. Drugs.com. (2020, February 3). Breast Lumpectomy (Discharge Care) - What You Need to Know. Retrieved September 09, 2020, from https://www.drugs.com/cg/breastlumpectomy-discharge-care.html Fairview. (n.d.). Patient Education. Retrieved September 09, 2020, from https://www.fairview.org/sitecore/content/Fairview/Home/PatientEducation/Articles/English/d/i/s/c/h/Discharge_Instructions_for_Lumpectomy_or_Breast_ Biopsy_83398 Home Care Assistance. (n.d.). Top 10 Foods to Eat After Surgery to Promote Healing. Retrieved September 09, 2020, from https://homecareassistance.com/blog/top-10-healing-foods-eatsurgery Breastcancer.org. (2018, October 16). Lumpectomy: What to Expect During and After Surgery. Retrieved September 09, 2020, from https://www.breastcancer.org/treatment/surgery/lumpectomy/expectations Breastcancer.org. (2019, March 09). Hematoma: A Side Effect of Treatment. Retrieved September 09, 2020, from https://www.breastcancer.org/treatment/side_effects/hematoma Breastcancer.org. (2019, March 09). Lymphedema: A Side Effect of Treatment. Retrieved September 09, 2020, from https://www.breastcancer.org/treatment/side_effects/lymphedema American Cancer Society. (2019, September 18). Exercises After Breast Cancer Surgery: Post Mastectomy Exercises. Retrieved September 09, 2020, from

https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breastcancer/exercises-after-breast-cancer-surgery.html Cancer.net. (2020, August 14). Breast Cancer - Follow-Up Care and Monitoring. Retrieved September 09, 2020, from https://www.cancer.net/cancer-types/breast-cancer/follow-careand-monitoring Cancer Research UK. (2020, July 13). Breast cancer. Retrieved September 09, 2020, from https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/lymphoedemaafter-treatment Marcin, A., & Azu, M., MD. (2020, July 12). How Does Breast Cancer Affect the Body? Retrieved September 09, 2020, from https://www.healthline.com/health/breast-cancer/howdoes-breast-cancer-affect-the-body Memorial Sloan Kettering Cancer Center. (n.d.). About Your Lumpectomy Surgery. Retrieved September 09, 2020, from https://www.mskcc.org/cancer-care/patient-education/aboutyour-lumpectomy-surgery Saint Luke's. (n.d.). Discharge Instructions for Mastectomy or Breast Lumpectomy. Retrieved September 09, 2020, from https://www.saintlukeskc.org/health-library/dischargeinstructions-mastectomy-or-breast-lumpectomy Saratoga Hospital Center for Breast Care. (n.d.). Discharge Instructions for Partial Mastectomy (Lumpectomy) Surgery [PDF]. Saratoga Hospital Center for Breast Care.