MATERNITY NURSING(CA MAMAY)

ANNISAULFALAH (011007 D3KI)

SITI FATIMAH (0110 D3KI)

INTERNATIONAL CLASS OF NURSING DIPLOMA PROGRAM

BANJARMASIN MUHAMMADIYAH HEALTY COLLEGE

ACADEMIC YEAR 2012/2013

ANATOMY AND PHYSIOLOGY MAMMAY

A. BREAST ANATOMY AND PHYSIOLOGY

1.Breast Anatomy

Breast (mammary, milk) is a gland that lies under the

skin, in the upper chest muscles. The function of breasts is

to produce milk to nourish the baby. Humans have a pair of

breast gland, which weighs over 200 grams, 600 grams during

pregnancy and while breastfeeding 800 grams.

In the breast there are three main parts, namely:

1.Corpus (body), which is part of the enlarged

Alveolar corpus, ie the smallest unit that produces milk.

Part of the alveoli is aciner cells, fat tissue, plasma

cells, smooth muscle cells and blood vessels

Lobule, which is a collection of the alveoli.

The lobes, lobules are some who gathered to 15-20 lobes in

each breast.

Breast milk is transferred from the alveoli into the small

channel (duktulus), then some duktulus combine to form a

larger channel (lactiferous duct)

2.Areola, the dark part in the middle

Lactiferous sinuses, which channels beneath the areola

widens, eventually converging to the nipple and empties out.

Inside the walls of the alveoli and ducts are muscle

contraction can be plain when pumping out.

3.Papilla or nipple, that protrusions at the top of the breast

Menojol parts are inserted into the baby's mouth for a

stream of milk

2.Physiological lactation

During pregnancy , the hormone

prolactin from the placenta is usually

increased but milk has not come out his

mind is still hampered by high levels of

estrogen. On the second or third day

after perasalinan, and progestero

decreased estrogen levels drastically,

so that prolactin is dominant and when

this started happening secretion of

breast milk. With the early going suckle

the nipple stimulation, formed prolactin

by the pituitary, thus smoother milk

secretion.

Two reflex in women is very

important in the process of lactation is

prolactin and reflex flow arising as a

result of stimulation of the nipple by

the baby's sucking.

1)reflexes prolactin

At the end of the pregnancy hormone prolactin plays a

role to make colostrum, is limited due to the activity of

prolactin is inhibited by estrogen and progesterone is still

high. Post oersalinan, the release of the placenta and

reduced function of the corpus luteum estrogen and

progesterone also reduced. Will stimulate the baby sucking

the nipple and breast prop because sensory nerve endings

that serve as mechanical receptors. Stimulation was

continued through the spinal cord to the hypothalamus

hypothalamus and inhibiting factors will depress spending

and otherwise stimulate prolactin secretion spending hyper

factor prolactin secretion. Factors hyper prolactin

secretion that stimulates the anterior pituitary prolactin

exit. This hormone stimulates the cells of the alveoli which

is used to make milk.

Prolactin levels in breastfeeding mothers will be a

normal 3 months after giving birth to weaning children and

at that time there will be no increase in prolactin despite

the baby's sucking, but the milk remains ongoing expenses.

In women postpartum who are not breastfeeding, prolactin

levels will be normal at week 2-3. While in nursing Ibi

prolactin will increase in a state such as stress or

psychological effects, anesthesia, surgery and nipple

stimulation.

2)let down reflex

Along with the formation of prolactin by the anterior

pituitary, stimulation from the baby's sucking continued to

posterior pituitary (neurohipofise) were then removed

oxytocin. Through this hormone into the bloodstream, causing

uterine contractions. Contraction of the cells to squeeze

out the milk that has been made out of the alveoli and enter

through the duct into the mouth lactiferus Created,

CA MAMMAY

A. DEFINITION

Ca breast is a group of abnormal cells that continue to grow

in the jaringanmammae (Tapan, 2005).

Ca breast is a cancer that attacks the breast tissue and

breast tissue causes cells to change shape to become abnormal

and multiply in an uncontrolled manner (Mardiana, 2004).

A condition in which cells lose their ability to control the

speed of division and growth. Normally, dead cells equals the

number of cells that grow. If the cell is already experiencing

malignancy / malignant or cancerous cells that divide

continuously without regard to need, thus forming a tumor or

developing "new growth" but not all that new growth is a

carcinogen. (Daniele gale 1996).

Breast cancer is a group of abnormal cells in the breast

that continues to grow in the form of a double. Eventually these

cells to form in the breast bejolan. If it is not a cancerous

lump removed or controlled, cancer cells can spread (metastasis)

to other body parts. Metastases can occur in lymph nodes (lymph

nodes) in the armpit or shoulder blades. Besides cancer cells

could be lodged in the bones, lungs, liver, skin, and

subcutaneous. (Erik T, 2005, p: 39-40)

B. ETIOLOGY

Currently, the data are certainly not found the main causes

mammary penyakitca. Until now, the occurrence of breast ca

allegedly caused by a complex interaction of many factors such

as genetic, environmental, and hormonal levels of the hormone

estrogen in the body excessively (Harianto, 2005).

C. RISK FACTORS

The etiology of breast cancer is not known with certainty.

However, some risk factors in patients were related to the

incidence of breast cancer. There are several risk factors that

may increase the occurrence of breast ca namely:

1.Family history

Women who have a family history of breast ca no one

suffers like the mother, sister, or brother / sister has

breast ca risk 2 to 3 times higher.

2.Hormone

The first menstruation (menarche) before age 10 years,

menopause (menopause) after the age of 55 years old, not

married or never have children, have children after the age of

35 years and never feed a child.

3.Age

Women aged> 30 years have a greater chance of breast

cancer and possibly got the increase after menopause.

4.Women who have had an infection, trauma / impact, breast

surgery due to benign tumors atatu contralateral malignant

tumor.

5.Women who received prior radiation to the breast or chest

wall.

6.Significant weight gain in adulthood.

7.Women who have had ovarian tumor surgery risk is 3 to 4 times

higher (Dalimartha, 2004).

8.Older oral contraceptives

9.Pattern of consumption of fatty foods

10. Lack of physical activity (Indarti, 2005).

D. PATHOPHYSIOLOGY

Ca mammary, like other malignancies cause of this malignancy

is multifaktoral both environmental and hereditary factors, such

as lesions in the DNA causing genetic mutations, mutations in

this gene can cause breast ca, immune system failure, abnormal

growth of the growth factor causes abnormal stimulation between

stromal cells with epithelial cells, a defect in DNA repair

genes such as BRCA1, BRCA2, which, in principle, increase the

activity and cell proliferation disorders that reduce or

eliminate the regulation of cell death (Heffner, 2005).

Ca mammary occur due to loss of control or breast cell

proliferation and apoptosis that breast cells proliferating

continuously. Loss of function of the inability to detect

apoptosis causes cell damage caused by DNA damage. When the p53

gene mutation as a function of the detection of DNA damage will

be lost, so that abnormal cells are continuously proliferating.

The increase in the number of abnormal cells form a lump is

generally called a tumor or cancer. Benign tumors usually a fat

blob encased in a container that resembles a pouch. Through the

bloodstream or lymph system, tumor cells and the toxins produced

out of the herd and spread to other parts of the body.

The cells are spread would then grow in a new place, which

eventually form a swarm of malignant tumor cells or a new

cancer. Malignancy of breast cancer cells to invade surrounding

nomal, especially the weak cells. Cancer cells will grow leaps

and bounds, so the patient will be larger breasts than usual.

Ca from the mammary gland epithelium and breast duct. Growth

begins in the ducts or glands called lobules noninvasive

carcinoma. Then the tumor broke through the outside wall of the

duct or lobule area kelenjarr and invasion into the stroma,

which is known as invasive carcinoma. The spread of tumor occurs

through the lymphatic vessels, and grow deposits in the lymph

nodes, so that the axillary lymph nodes or enlarged

supraklavikuler. Ca mammary gland was first spread to the

axillary region. What most distant metastases are bone, liver,

lung, pleura, and brain (Heffner, 2005).

E. TYPES

Type Ca mammae by histopathologic picture:

1.Ductal carcinoma menginflitrasi

Is the most common histopathological type, constitute 75% of

all breast cancers. Cancer is very clear because it is hard on

palpation. This type of cancer often metastasizes to the

axillary nodes, bone, lung, liver and brain

2.Infiltrating lobular carcinoma

This type is generally multisentris, some areas of

thickening can occur in one or both mammary. Lobular

carcinomas usually metastasize to the meningeal surface.

3.Carcinoma of the modular

At 6% modular carcinoma grows in a capsule, it can be

great but spread slowly, so the prognosis is often better.

4.Mucinous carcinoma

At 3% mucinous carcinoma is mucus, also grow slowly.

5.Ductal carcinoma-tubular

Only 2% and rarely occurs, because axillary metastases

histologically unusual the prognosis is very good.

6.Carcinoma inflamantori

It is a rare type of breast carcinoma (1-2%) and cause

symptoms that are different from other breast carcinomas.

These tumors tenderness and intense pain, abnormal mammary

hard and enlarged. Red skin over the tumor and a little black.

It often happens mammary papilla edema and retraction

(Prawirohardjo, 2005).

F. STAGE BREAST CANCER

stadium in cancer, is to describe the condition of the

cancer, the location, to which the distribution, the extent of

its influence on other organs. Doctors use tests to determine

the stage of cancer. So the stage could not be determined if the

tests do not complete / finished. By knowing the stage, this is

one way which helps your doctor to determine what is the

appropriate treatment for patients.

One way that doctors use to describe the stage of the cancer is the TNM system.

This system uses three criteria to determine the stage of cancer. Namely:

1.The tumor itself. How big is the size of the tumor and where

it is located (T, tumor)

2.Lymph nodes around the tumor. Whether the tumor has spread

kekelenjar surrounding lymph? (N, Node)

3.The possibility of the tumor has spread to other organs (M,

Metastasis)

STADIUM 0:

Carsinoma called Ductal In Situ or Noninvasive Cancer. That the

cancer does not spread out of the vessel / breast ducts and

glands (lobules) of the breast milk.

I STADIUM

The tumor is still very small and has not spread, and there is

no point in the lymph vessels

STADIUM IIa:

Patients in this condition:

Tumor diameter less than or equal to 2 cm and have been found

at points in the lymph channels in the armpit (axillary nodes

limph)

Tumor diameter wider than 2 cm but not more than 5 cm. Has not

spread to the points in the armpit lymph vessels (limph

axillary nodes).

There is no sign of a tumor in the breast, but was found at the

points in the armpit lymph vessels.

STADIUM IIB:

Patients in this condition:

1.Tumor diameter wider than 2 cm but not exceeding 5 cm.

2.Has spread in the points in the armpit lymph vessels.

3.Tumor diameter wider than 5 centimeters but has not spread.

STADIUM III A:

Patients in this condition:

Tumor diameter smaller than 5 centimeters and has spread to the

points in the armpit lymph vessels.

Tumor diameter greater than 5 cm and has spread to the points

in the armpit lymph vessels.

.

STADIUM III B:

The tumor has spread to the chest wall or swelling may also

cause ulcers in the breast. Or diagnosed as Inflammatory Breast

Cancer. Could have been or could also have spread to the points

in the lymph vessels in the armpit and upper arm, but did not

spread to other parts of the body organs.

STADIUM IIIC:

As stage IIIB, but has spread to the points in the lymph vessels

in the group N3 (cancer has spread more than 10 points below the

lymph duct collarbone).

STADIUM IV:

Tumor size can be whatever, but it has spread

to distant locations, namely:

Bone, lung, liver or ribs.

G. SIGNS AND SYMPTOMS

According Suryaningsih 2009, the signs and symptoms are:

1.Bumps

A lump in the breast that can be touched by hand. The

longer the hardened lumps and irregular shape.

2.Skin changes on the breast

a.Skin interested (skin dimpling)

b.Bumps that can be seen (visible lump)

c.Erythema

d.Ulcers

3.Abn ormalities in putting

a.Putting interested (nipple retraction)

b.Eczema

c.Fluid on putting (nipple discharge)

H. DIAGNOSTIC EXAMINATION

a.Mammography

With this test can be found even small bumps. When a tumor

is suspected clinically and on mammography can not find

anything, the examination should be followed by a biopsy for

carcinoma is often not visible on the mammogram. Conversely,

if a positive mammography and clinical examination was not

palpable tumor should be continued with a puncture or biopsy.

b.Ulrasonografi

Ultrasound is usually used in conjunction with

mammography, in order to distinguish fluid-filled cyst or a

solid. To determine the stage to use photographs of thoracic,

abdominal ultrasound, Bone scan and CT scan.

c.X-thorax photo

Can help identify and detect the presence of malignancy

metastatic to the lung.

d.Fine Needle Biopsy Examination

Cytology is where the materials were obtained from the

needle puncture of the lesion that can be used to determine

whether surgery will be prepared with the preparation of

frozen or will be followed by other tests. How this

examination has a high sensitivity and specificity, but can

not confirm the absence of malignancy. Negative result on this

test could mean that the needle biopsy is not about the

ferocity that excisional biopsy is needed to confirm the

results remained negative (Sjamsuhidayat, 2004).

I. TREATMENT

Treatment begins after a thorough assessment of the

condition of the patient, which is about 1 week or more after

the biopsy. Treatment consists of surgery, radiation therapy,

chemotherapy and hormone inhibitors.

1.Surgery

a.Mastectomy

Mastectomy is the surgical removal of the breast. There

are three types of mastectomy are:

1)Radycal Modified Mastectomy, the surgical removal of the

entire breast, breast tissue in the sternum, collarbone

and ribs, and lump around the armpit.

2)Total (Simple) Mastectomy, the surgical removal of the

entire breast, without glands in the armpit.

3)Radical Mastectomy, the surgical removal of part of the

breast. Lumpectomy is usually called, is merely the

removal of tissue containing cancer cells, instead of the

whole breast. Usually lumpectomydirekomendasikan in

patients with large tumor less than 2 cm and located on

the edge of the breast.

b.Lymph node (KGB) Armpit.

Appointment Armpit KGB carried out on patients with

breast ca spread but large tumor more than 2.5 cm (Tapan,

2005).

2.Non Surgery

a.Radiation Therapy

Radiation is the process of radiation to the affected

area ca using X-rays and gamma rays are aimed at killing any

remaining cancer cells after surgery dimammae. The effect of

this treatment is the body becomes weak, poor appetite, skin

color around the breast to black and hemoglobin and

leukocytes tended to decline as a result of radiation.

b.Chemotherapy

Chemotherapy is the administration of anti-cancer drugs

in pill or capsule or liquid through the infusion aimed at

killing cancer cells. These drugs not only kill cancer cells

in the breast, but also all the cells in the body. The

effects of chemotherapy are patients experienced nausea and

vomiting and hair loss. Systematic after mastectomy,

palliative in advanced disease.

c.Hormone therapy and endocrine

Hormone made if the disease has systemic form distant

metastases. Hormonal therapy is usually given prior

palliative chemotherapy.

Inhibiting hormone medications (drugs that affect the

hormones that support the growth of cancer cells) is used to

suppress the growth of cancer cells throughout the body.

Given to cancer that has spread, taking estrogen, androgen,

antiestrogen, coferektomi hipofisektomi adrenalectomy

(Tapan, 2005).

FETAL CONDITION DUE TO BREAST CANCER MOM

No deleterious effects on the fetus from the mother's breast

cancer has been proven, and there are no reported cases of breast

cancer cell transfer of fetal-maternal.

CONSEQUENCES OF PREGNANCY IN PATIENTS WITH A HISTORY OF BREAST CANCER

Based on retrospective data, pregnancy does not seem to

jeopardize the survival of women with a history of breast cancer, and

no deleterious effects have been demonstrated in the fetus. Some

doctors recommend that patients wait 2 years after diagnosis before

trying to conceive.

Effective treatment, including surgery and chemotherapy can be

administered at certain phases of pregnancy. Treatment is based on

the stage of fetal development and the stage of cancer development.

The use of radiation therapy during the first and second trimester of

pregnancy is not recommended because of the inability to protect

babies from cancer radiation. In early pregnancy, the treatment given

is usually composed of a mastectomy followed by chemotherapy in the

second trimester. Chemotherapy given after the first trimester so do

not put the fetus at greater risk, although low birth weight.

Women in advanced stages of cancer have more difficult choices,

whether they should postpone treatment until after birth, or using a

less aggressive treatment of chemotherapy that may not be effective

against their cancer. It is important for women to face transform and

discuss the implications of these options with doctors and

specialists, as well as to get support from their friends, family,

and partners.

Some women can get pregnant after breast cancer, but because not

enough research has been done, then women should consult a doctor if

considering pregnancy. It is important to realize that certain cancer

treatments can affect a person's ability to bear children will

require careful consideration and planning to preserve fertility

before and during treatment.

There are several clinical issues that need to be considered

when thinking about pregnancy after breast cancer:

Estrogen - receptor status of the cancer cells.

If the cancer cells have estrogen receptor positive, it may be more

at risk of getting pregnant. With the hormonal surges of estrogen and

progesterone associated with pregnancy, it can allow for the cancer

cells to become active inactive.

The impact of chemotherapy on the ovaries. (Impact of

chemotherapy on the ovaries)

At birth, every woman is born with a complete egg in the ovaries for

a lifetime, spending a month each in accordance with the menstrual

cycle. However, chemotherapy can damage ovrium in a variety of ways.

Even if the women who had experienced menopause cancer, chemotherapy

may actually kill more eggs, or it may have damaged the remaining

egg, so they may not be able to conceive or can cause genetic

defects. To some extent, the content specialist can determine the

quality of the eggs, and if she is successful pregnancy. Treatment

did not cause immediate menopause but accelerate the menopause.

Year of survival Although there is little debate, some

oncologists recommend to wait until the past five years since the

success of therapy to consider pregnancy because it may impact on

your body. Others recommend just waiting for two years.

Limited fertility options: Patients with a history of cancer may not

be able to get pregnant the natural way, for various reasons, some of

which may have nothing to do with your cancer history. But as a

victim of cancer, fertility treatment options may be more limited, as

many fertility programs including significant hormonal stimulation.

Extended Treatment: Some women require additional hormonal

therapy after treatment, such as 5 years of tamoxifen, which could

further delay pregnancy.

J. NURSING CARE REPORT

1.Assessment

a.Data biography / bio

Includes client identity: name, age, gender, religion,

education, occupation, and address.

b.History of complaints

1)Complaints in the breast or armpit and a history of the

disease:

Bumps, speed of growth, pain, nipple discharge, nipple

retraction, and since when, crusting on the areola, skin

disorders: dimpling, peau d'orange, ulceration, venektasi,

skin discoloration, lump armpit, arm edema.

2)Complaints elsewhere related to metastasis:

Painful bone (vertebra, femur), a feeling of fullness

in the pit of the stomach, coughing, tightness, severe

headache.

c.Risk Factors

Patient age, age of first child, have a child or

unlicensed, history of breastfeeding, history of

menstruation: first menstrual age, regularity of menstrual

cycle, menopause age, history of hormonal drug use, family

history of breast cancer or with respect to other cancers, a

history of surgery ever breast tumors, a history of chest

wall radiation.

d.The physical examination includes:

1.Status generalist

2.Status location:

Right and left breast should be checked

Period tumors: location, size, consistency, surface, shape

and boundaries of the tumor, number of tumors, fixed or

not to the surrounding breast tissue, skin, m. pectoral

and chest wall.

Skin changes: redness, dimpling, edema, nodules, peau

d'orange, ulceration.

Nipple: interested, erosion, crusting, discharge.

Lymph node status:

Axillary Lymph node: the number, size, consistency

Lymph node infra clavicle

Supraclavicular Lymph node

Examination of the area of suspected metastasis: What

organs (lung, bone, liver, brain).

3.Body weight and height

4.Head to toe assessment

e.Laboratory tests include:

1.Blood tests are usually decreased hemoglobin, increased

leukocytes, platelets increase if there is spread of urea

and creatinine.

2.Examination of the urine, examined whether increased urea

and creatinine.

3.Diagnostic tests commonly performed on patients with

breast ca is the X-ray, ultrasound, xerora diagrafi,

diaphanografi and examination hormone receptors.

f.Assessment of patterns of everyday life include:

1.Nutrition

Eating habits, frequency of eating, appetite, food

taboos, food preferences, the number of drinking. Studied

history before and after admission.

2.Elimination

CHAPTER habit / bladder, frequency, color, consistency,

before and after admission.

3.Rest and sleep

Sleeping habits, the amount of sleep the day before and

after illness.

4.Personal hygiene

The frequency of bathing and brushing your teeth

daily, the frequency of washing hair in a week, assessed

before and at the hospital.

5.Identification of psychological problems, social, and

spiritual.

Psychological Status: Emotions are usually irritable,

angry, anxious, patients expect a speedy recovery, feel

foreigners stay in the hospital, feeling inferior,

negative coping mechanisms.

Social Status: Feeling isolated due to lack of clients

interact with other people.

Spiritual Status: Client in worship.

NURSING DIAGNOSIS

a.Acute Pain / Chronic related to the suppression of tumor mass

b.Integrity of the skin or tissue damage associated with changes in

circulation, edema, tissue destruction

c.Imbalance nutrition less than body requirements related to

inadequate intake and hipermetabolisme.

d.The risk of infection associated with wound infection

e.Anxiety associated with changes in body image

f.Body image disturbance associated with loss or alteration of

mammary and mammary picture.

g.Lack of knowledge about the condition, prognosis, and treatment of

illnesses related to lack of information.

INTERVENTION

a.Acute Pain / Chronic related to the suppression of tumor mass.

Goal: Pain is reduced or the client can be resolved

Expected outcomes:

1)Clients say the pain is reduced, pain scale 2-3 or lost.

2)Tender no.

3)Facial expressions quiet, rest, sleep.

4)Identifying the causes and uses measures to prevent pain.

Intervention (NIC) Rational a.komphrehensif Assess the

location, characteristics,

duration, frequency, scale,

and intensity of pain.

b.Provide information on pain

a. To determine the extent to

which the development of

the pain felt by the

client so that it can be

used as a reference for

further intervention.

clients include causing pain

and pain intensity.

c.Position the patient to

provide comfort.

d.Teach the use of non-

pharmacological techniques

(relaxation, guided

emergency, music therapy,

distraction, hot and cold

applications, massage, TENS,

hypnosis, play therapy,

activity therapy

acupressure).

e.Increase sleep / rest.

f.Monitor TTV before and after

the first analgesic.

g.Determine the analgesic of

choice, route of

administration and optimal

dosage

b. Clients can control the

pain.

c. May affect the client's

ability to relax / rest

effectively and can reduce

pain.

d. Relaxation techniques can

make the client feel

comfortable and a little

distraction to divert the

attention of clients to

pain so that it can help

reduce the pain.

e. The need for sleep / rest

being met and how to

reduce the pain.

f. Changes in vital signs,

especially temperature and

pulse rate is one

indication of increased

pain experienced by the

client.

g. Analgesic drugs block the

pain receptors so that the

pain can be perceived

tidat.

b.Integrity of the skin or tissue damage associated with changes in

circulation, edema, tissue destruction.

Goal: Damage to skin integrity can be resolved.

Criteria results:

a.Good skin integrity can be maintained (sensation, elasticity,

temperature, hydration, pigmentation)

b.Good tissue perfusion

c.Shows the process of wound healing

Intervention (NIC) Rational a.Instruct patient to use loose

clothing

b.Keep your skin clean and dry

it.

c.Monitor the reddish skin

d.Observation wound: location,

dimension, depth of the wound,

characteristics, liquid color,

granulation, necrotic tissue,

signs of local infection.

e.Mobilization of patients

(change the patient's

position) every two hours

a.Prevent irritation and

pressure of clothes.

b.The area that is moist and

contaminated a medium for

the growth of pathogenic

organisms.

c.This area is at increased

risk for damage and

require more intensive

treatment.

d.Prevent bleeding and

infection.

e.Improve circulation and

skin perfusion pressure by

preventing long on the

network. c.Imbalance nutrition less than body requirements related to

inadequate intake and hipermetabolisme.

Goal: The nutritional requirements of clients are met

Criteria results:

a.An increase in BB fit for purpose.

b.The client indicates a stable weight.

c.Clients participate in specific interventions to stimulate

appetite

Intervention (NIC) Rational a.Provide information about

nutritional needs.

b.Collaboration with a

nutritionist to determine the

amount of calories and

a.Increasing patient

knowledge regarding

nutritional needs.

b.Helping patients get

balanced nutrition

nutrients it needs patients.

c.Monitor food preferences.

d.Monitor intake of calories and

nutrients.

e.Encourage the patient to

consume nutrient-rich high-

calorie diet, with adequate

fluid intake.

according to the needs of

the body.

c.Generating patient's

appetite.

d.Knowing the number of

calories and the amount of

nutrients that enter.

e.Ditingkatkam metabolic

network needs as well as

liquids.

d.The risk of infection associated with surgical wound infections

Goal: Clients will be free of infection.

Criteria results:

a.Clients are free from signs and symptoms of infection.

b.Demonstrated ability to prevent infection.

Intervention (NIC) Rational a.monitor signs and symptoms of

systemic and local infections.

b.Inspection condition of

wound / surgical incision.

c. Teach how to avoid infection

a.Knowing the early symptoms

of the infection process.

b.Early detection of

infection allows the

development to act

immediately and prevent

further complications.

c.Improving patients'

knowledge about how to

prevent infection.

e.Anxiety associated with changes in body image

Goal: Anxiety can be reduced

Expected outcomes:

a.Clients are able to identify, express and demonstrate techniques

to control anxiety

b.Vital sign within normal limits

c.Posture, facial expressions, body language and activity levels

showed reduced anxiety.

Intervention (NIC) Rational a.Identify the level of anxiety.

Explain all procedures and

what is felt during the

procedure.

b.Provide factual information

about diagnosis, prognosis

action.

c.Encourage the patient to

express feelings of fear

perception.

d.Listen attentively.

e.Accompany patients to provide

security and reduce fear.

f. Instruct the patient to use

relaxation techniques.

a.Knowing the extent to

which they interfere with

the client's anxiety.

b.Increasing knowledge of

the procedure for the

patient.

c.Adding knowledge of the

client so that the client

knows and understands

about the disease.

d.Expression of feelings can

provide a sense of relief

that reduces anxiety.

e.By listening to customer

complaints empathetically

then the client will feel

cared for.

f.Creating peace of mind

that anxiety can be

reduced.

g.Provide peace and reduce

anxiety.

REFERENCE

Azamris. 2006. Analisis Faktor Risiko pada Pasien Kanker

Payudara di Rumah Sakit Dr. M. Djamil Padang. Jurnal Cermin

Dunia Kedokteran No. 152.

Dalimartha, Setiawan. 2004. Deteksi Dini Kanker dan Simplisia

Anti Kanker. Jakarta : Penebar Swadaya.

Harianto, Rina M dan Hery S. 2005. Risiko Penggunaan Pil

Kontrasepsi Kombinasi Terhadap Kejadian Kanker Payudara pada

Reseptor KB di RS Dr. Cipto Mangunkusumo, Jakarta:Majalah Ilmu

Kefarmasian, Vol. 2, No.1, hh. 84-99.

Heffner, Linda J dan Danny J Schust. 2005. At Glance Sistem

Reproduksi Edisi Kedua.Jakarta : Erlangga.

Ibrahim, Syarif dan Syarifuddin Wahid. 2010. Immunotherapy on

Breast Cancer. The Indonesia Journal of Medical Science Volume 2

No 1 Juli 2010 p.54-60.

Indarti, Rini dan Henry Setiawan. 2005. Faktor-Faktor Risiko

yang Berpengaruh Terhadap Kejadian Kanker Payudara. Magister

Programme of Epidemiology, University ofDiponegoro, Semarang,

Indonesia No 5248.

Mardiana, Lina. 2004. Kanker pada Wanita, Pencegahan dan

Pengobatan dengan Tanaman. Jakarta : Penebar Swadaya.

Prawirohardjo, Sarwono. 2005. Ilmu Kandungan. Jakarta : Yayasan

Bina Pustaka.

Sjamsuhidayat, R. 2004. Buku Ajar Ilmu Bedah Edisi 2. Jakarta :

EGC.

Tapan, Erik. 2005. Kanker, Antioksidan, dan Terapi Komplementer.

Jakarta : Elex Media Komputindo.

Tim Penanggulangan dan Pelayanan Kanker Payudara Terpadu

Paripurna RS Kanker Dharmais. 2002. Penatalaksanaan Kanker

Payudara Terkini Edisi 1 Cetakan 1. Jakarta : Pustaka Populer

Obor.

Tjindarbumi, D. 2002. Deteksi Dini Kanker Payudara dan

Penanggulangannya dalam Deteksi Dini Kanker. Jakarta : FK UI.

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