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.
The 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 Care Plans Related to Breast Cancer
Acute Pain Care Plan
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
- Tumor advancement causing inflammation and compression on nerves and bones
As evidenced by:
- Verbalization of pain
- Body language/guarding behavior
- Facial grimacing
- Changes in vital signs
- Patient will verbalize pain is reduced or controlled
- Patient will demonstrate the ability to perform ADLs due to improved comfort
Acute Pain 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.
Acute Pain 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.
Fear/Anxiety Care Plan
Fear and anxiety can be caused by the unknown that comes with a breast cancer diagnosis.
Nursing Diagnosis: Anxiety
- 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
- Shortness of breath or heart-pounding sensation (acute panic)
- Difficulty concentrating
- Lack of appetite
- 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
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.
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 Care Plan
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
- 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
- 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
Impaired Skin Integrity 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.
Impaired Skin Integrity 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.
References and Sources
- Anxiety. (n.d.). Cancer.Net. Retrieved March 16, 2022, from https://www.cancer.net/coping-with-cancer/managing-emotions/anxiety
- Breast cancer – Diagnosis and treatment. (2021, October 16). Mayo Clinic. Retrieved March 19, 2022, from https://www.mayoclinic.org/diseases-conditions/breast-cancer/diagnosis-treatment/drc-20352475
- Breast Cancer: Lymphedema After Treatment. (n.d.). Johns Hopkins Medicine. Retrieved March 19, 2022, from 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. (2017, December 15). Radiation Dermatitis: Recognition, Prevention, and Management. Cancer Network. Retrieved March 17, 2022, from https://www.cancernetwork.com/view/radiation-dermatitis-recognition-prevention-and-management
- Odhner, M. (n.d.). Nonverbal Pain Scale (NVPS) for Nonverbal Patients. MDCalc. Retrieved March 15, 2022, from https://www.mdcalc.com/nonverbal-pain-scale-nvps-nonverbal-patients
- Treating Cancer Pain. (n.d.). Memorial Sloan Kettering Cancer Center. Retrieved March 16, 2022, from 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. Retrieved March 15, 2022, from https://www.cdc.gov/cancer/breast/basic_info/what-is-breast-cancer.htm