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1. Sue Chan's just returned to her surgical unit after having a right radical mastectomy.
She has a surgical evacuator in her incision site and an I.V. line in her left hand.
Care begins by reassuring Ms. Chan, even if she seems groggy from the anesthetic.
Place her in whichever position is most comfortable for her. (But don't position her
on her right side.) Be sure her head is slightly elevated. Position pillows under her
right arm to reduce arm edema.
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2. Next, using Ms. Chan's left arm, her blood pressure is taken. Also, her pulse and
respiration rate is checked and recorded on her chart. Her vital signs are taken every
hour for the first 4 hours and every 4 hours for the next 16 hours. Then, if her vital
signs are stable, they will be checked at 8-hour intervals.
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3. Each time Ms. Chan's vital signs are taken, the dressing over her incision is examined
for signs of excessive bleeding. The surgical evacuator is also checked, as seen here.
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4. If Ms. Chan is awake, she is encouraged to cough and deep breathe. She receives
an explanation that because of her surgery, deep breathing and coughing may be painful.
Pain medication is ordered and administered before she begins. She is shown how to
splint her incision site with a pillow or folded towel, as shown, and receives
instruction on using an incentive spirometer every 2 hours for 24 to 36 hours after
surgery, as ordered by her health care provider.
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5. To promote circulation, Ms. Chen has her position changed and she performs leg
exercises every 2 hours. As soon as she is able, she begins exercising her affected
right arm.
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6. Ms. Chan's health care provider will probably want to make the first dressing
change after surgery. After that, Ms. Chan's dressing will be changed, as ordered,
every 24 hours or whenever it becomes wet or soiled.
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7. Twice each day -- morning and evening -- the amount of edema in Ms. Chan's right
arm is recorded in her chart. This is done by measuring the circumference of the
largest part of her forearm, approximately 5 inches (12.7 cm) above her wrist, as is
seen here.
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8. Also, the circumference of the largest part of her right upper arm, about 5 inches
(12.7 cm) above her elbow is measured. The measurements of her affected right arm are
compared with the pre-operation measurements, if this is possible. Or the measurements may be
compared to her unaffected left arm. All procedures and observations are documented.
Any teaching and assessments of Ms. Chan's reactions are also documented. Evacuator drainage is
included in the intake and output records.
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MoonDragon's Obgyn Information: Breast Cancer
