{
  "name": "Mastectomy",
  "slug": "mastectomy",
  "url": "https://nursingplex.com/care-plans/mastectomy",
  "category": "Surgery & Perioperative",
  "summary": "Breast removal care addressing drains, lymphedema prevention, arm exercises and body image.",
  "nursing_diagnoses": [
    "Disturbed body image",
    "Acute pain",
    "Impaired physical mobility",
    "Risk for infection"
  ],
  "overview": [
    "Mastectomy is surgical removal of breast tissue for cancer or high genetic risk. It ranges from simple (total) mastectomy to modified radical mastectomy with axillary node dissection, and may be combined with sentinel node biopsy or immediate reconstruction.",
    "Removing axillary lymph nodes disrupts lymph drainage, creating a lifelong risk of lymphedema and restricting how the affected arm may be used for blood pressure, venipuncture and injections. Nerve involvement can also cause numbness along the inner arm.",
    "Nursing care balances physical recovery — drains, seroma, shoulder mobility — with the profound body image, sexuality and mortality concerns that accompany breast loss."
  ],
  "key_facts": [
    {
      "label": "Affected arm rule",
      "text": "No blood pressure, venipuncture or injections in the arm on the surgical side after node dissection."
    },
    {
      "label": "Drains",
      "text": "Jackson-Pratt drains stay until output falls below about 30 mL per 24 hours for two consecutive days."
    },
    {
      "label": "Positioning",
      "text": "Elevate the affected arm on a pillow to promote lymph drainage and reduce swelling."
    },
    {
      "label": "Exercise",
      "text": "Begin hand and elbow movement early; progress to shoulder abduction and external rotation as the surgeon permits."
    }
  ],
  "nursing_priorities": [
    "Monitor the incision, flap viability and drain output.",
    "Prevent and detect lymphedema early.",
    "Restore shoulder range of motion progressively.",
    "Manage pain and phantom or neuropathic sensations.",
    "Support body image, grief and partner communication."
  ],
  "assessment": {
    "subjective": [
      "Reports of incisional pain, tightness or arm heaviness",
      "Expressions of loss, fear of recurrence or altered attractiveness",
      "Reports of numbness or tingling along the inner arm",
      "Questions about reconstruction, prostheses and returning to activity"
    ],
    "objective": [
      "Incision and skin-flap color, drainage and approximation",
      "Drain volume, color and patency",
      "Circumference measurements of both arms for early lymphedema",
      "Shoulder range of motion and grip strength",
      "Signs of infection: fever, spreading erythema, purulence"
    ],
    "related_factors": [
      "Surgical removal of breast tissue and lymph nodes",
      "Disrupted lymphatic drainage",
      "Nerve transection during dissection",
      "Loss of a body part associated with identity and sexuality"
    ]
  },
  "goals": [
    "The client will maintain intact skin flaps and remain free from infection.",
    "The client will regain functional shoulder range of motion.",
    "The client will remain free from lymphedema or report it early.",
    "The client will express feelings about the change in body appearance."
  ],
  "interventions": [
    {
      "title": "Wound and drain care",
      "points": [
        "Assess flaps for pallor, duskiness or excessive drainage each shift.",
        "Strip and empty drains as ordered, recording output and teaching the patient to do the same.",
        "Support the arm on a pillow with the elbow above the wrist.",
        "Report fever, foul drainage or a rapidly enlarging fluid collection."
      ]
    },
    {
      "title": "Lymphedema prevention",
      "points": [
        "Post a sign and inform staff: no BP, needlesticks or IVs in the affected arm.",
        "Teach avoidance of tight sleeves, jewelry, heavy lifting and cuts or burns on that side.",
        "Measure arm circumference at set points and compare with the other side.",
        "Refer to lymphedema therapy for sleeves or manual drainage if swelling appears."
      ]
    },
    {
      "title": "Mobility and psychosocial support",
      "points": [
        "Start hand-squeezing and elbow flexion on day one; add wall-climbing and pulley exercises when cleared.",
        "Provide analgesia before exercise sessions.",
        "Encourage the patient to view the incision when ready and to voice fears.",
        "Discuss prosthesis fitting, reconstruction options and survivor support groups."
      ]
    }
  ],
  "patient_teaching": [
    "Demonstrate drain care, measurement and recording before discharge.",
    "Review the lifelong affected-arm precautions and skin protection.",
    "Teach the prescribed exercise progression and when to advance.",
    "Emphasize follow-up imaging, oncology appointments and self-examination of the remaining breast."
  ]
}