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http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
http://NurseReview.org Cancer Nursing
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http://NurseReview.org Cancer Nursing

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  • 1. Oncology Nursing Nurse Licensure Examination Review
  • 2. Oncology defined
    • Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia
  • 3. “Root words”
    • Neo- new
    • Plasia- growth
    • Plasm- substance
    • Trophy- size
    • +Oma- tumor
    • Statis- location
  • 4. “Root words”
    • A- none
    • Ana- lack
    • Hyper- excessive
    • Meta- change
    • Dys- bad, deranged
  • 5. Characteristics of Neoplasia
    • Uncontrolled growth of Abnormal cells
    • 1. Benign
    • 2. Malignant
    • 3. Borderline
  • 6. Characteristics of Neoplasia
    • BENIGN
    • Well-differentiated
    • Slow growth
    • Encapsulated
    • Non-invasive
    • Does NOT metastasize
  • 7. Characteristics of Neoplasia
    • MALIGNANT
    • Undifferentiated
    • Erratic and Uncontrolled Growth
    • Expansive and Invasive
    • Secretes abnormal proteins
    • METASTASIZES
  • 8.  
  • 9.  
  • 10. Nomenclature of Neoplasia
    • Tumor is named according to:
    • 1. Parenchyma, Organ or Cell
    • Hepatoma- liver
    • Osteoma- bone
    • Myoma- muscle
  • 11. Nomenclature of Neoplasia
    • Tumor is named according to:
    • 2. Pattern and Structure, either GROSS or MICROSCOPIC
    • Fluid-filled  CYST
    • Glandular  ADENO
    • Finger-like  PAPILLO
    • Stalk  POLYP
  • 12. Nomenclature of Neoplasia
    • Tumor is named according to:
    • 3. Embryonic origin
    • Ectoderm ( usually gives rise to epithelium)
    • Endoderm (usually gives rise to glands)
    • Mesoderm (usually gives rise to Connective tissues)
  • 13. BENIGN TUMORS
    • Suffix- “OMA” is used
    • Adipose tissue- LipOMA
    • Bone- osteOMA
    • Muscle- myOMA
    • Blood vessels- angiOMA
    • Fibrous tissue- fibrOMA
  • 14. MALIGNANT TUMOR
    • Named according to embryonic cell origin
    • 1. Ectodermal, Endodermal, Glandular, Epithelial
    • Use the suffix- “CARCINOMA”
    • Pancreatic AdenoCarcinoma
    • Squamos cell Carcinoma
  • 15. MALIGNANT TUMOR
    • Named according to embryonic cell origin
    • 2. Mesodermal, connective tissue origin
    • Use the suffix “SARCOMA
    • FibroSarcoma
    • Myosarcoma
    • AngioSarcoma
  • 16. “PASAWAY”
    • 1. “OMA” but Malignant
      • HepatOMA, lymphOMA, gliOMA, melanOMA
    • 2. THREE germ layers
      • “ TERATOMA”
    • 3. Non-neoplastic but “OMA”
      • Choristoma
      • Hamatoma
  • 17. CANCER NURSING
    • Review of Normal Cell Cycle
    • 3 types of cells
    • 1. PERMANENT cells- out of the cell cycle
      • Neurons, cardiac muscle cell
    • 2. STABLE cells- Dormant/Resting (G0)
      • Liver, kidney
    • 3. LABILE cells- continuously dividing
      • GIT cells, Skin, endometrium , Blood cells
  • 18. CANCER NURSING
    • Cell Cycle
    • G0------------------G1  S  G2  M
    • G0- Dormant or resting
    • G1- normal cell activities
    • S- DNA Synthesis
    • G2- pre-mitotic, synthesis of proteins for cellular division
    • M- Mitotic phase (I-P-M-A-T)
  • 19. CANCER NURSING
    • Proposed Molecular cause of CANCER:
    • Change in the DNA structure  altered DNA function  Cellular aberration
    •  cellular death
    •  neoplastic change
    • Genes in the DNA- “proto-oncogene” And “anti-oncogene”
  • 20. CANCER NURSING
    • Etiology of cancer
    • 1. PHYSICAL AGENTS
    • Radiation
    • Exposure to irritants
    • Exposure to sunlight
    • Altitude, humidity
  • 21. CANCER NURSING
    • Etiology of cancer
    • 2. CHEMICAL AGENTS
    • Smoking
    • Dietary ingredients
    • Drugs
  • 22. CANCER NURSING
    • Etiology of cancer
    • 3. Genetics and Family History
    • Colon Cancer
    • Premenopausal breast cancer
  • 23. CANCER NURSING
      • Etiology of cancer
    • 4. Dietary Habits
    • Low-Fiber
    • High-fat
    • Processed foods
    • alcohol
  • 24. CANCER NURSING
    • Etiology of cancer
    • 5. Viruses and Bacteria
    • DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus
    • RNA Viruses- HIV, HTCLV
    • Bacterium- H. pylori
  • 25. CANCER NURSING
    • Etiology of cancer
    • 6. Hormonal agents
    • DES
    • OCP especially estrogen
  • 26. CANCER NURSING
    • Etiology of cancer
    • 7. Immune Disease
    • AIDS
  • 27. CANCER NURSING
    • CARCINOGENSIS
    • Malignant transformation
    • I  P  P
    • Initiation
    • Promotion
    • Progression
  • 28. CANCER NURSING
    • CARCINOGENSIS
    • INITIATION
    • Carcinogens alter the DNA of the cell
    • Cell will either die or repair
  • 29. CANCER NURSING
    • CARCINOGENSIS
    • PROMOTION
    • Repeated exposure to carcinogens
    • Abnormal gene will express
    • Latent period
  • 30. CANCER NURSING
    • CARCINOGENSIS
    • PROGRESSION
    • Irreversible period
    • Cells undergo NEOPLASTIC transformation then malignancy
  • 31. CANCER NURSING
    • Spread of Cancer
    • 1. LYMPHATIC
        • Most common
    • 2. HEMATOGENOUS
      • Blood-borne, commonly to Liver and Lungs
    • 3. DIRECT SPREAD
      • Seeding of tumors
  • 32. CANCER NURSING
    • Body Defenses Against TUMOR
    • 1. T cell System/ Cellular Immunity
      • Cytotoxic T cells kill tumor cells
    • 2. B cell System/ Humoral immunity
      • B cells can produce antibody
    • 3. Phagocytic cells
      • Macrophages can engulf cancer cell debris
  • 33. CANCER NURSING
    • Cancer Diagnosis
    • 1. BIOPSY
      • The most definitive
    • 2. CT, MRI
    • 3. Tumor Markers
  • 34. CANCER NURSING
    • Cancer Grading
    • The degree of DIFFERENTIATION
    • Grade 1- Low grade
    • Grade 4- high grade
  • 35. CANCER NURSING
    • Cancer Staging
    • 1. Uses the T-N-M staging system
    • T- tumor
    • N- Node
    • M- Metastasis
    • 2. Stage 1 to Stage 4
  • 36. CANCER NURSING
    • GENERAL MEDICAL MANAGEMENT
    • 1. Surgery- cure, control, palliate
    • 2. Chemotherapy
    • 3. Radiation therapy
    • 4. Immunotherapy
    • 5. Bone Marrow Transplant
  • 37. CANCER NURSING
    • GENERAL Promotive and Preventive Nursing Management
    • 1. Lifestyle Modification
    • 2. Nutritional management
    • 3. Screening
    • 4. Early detection
  • 38. SCREENING
    • 1. Male and female- Occult Blood, CXR, and DRE
    • 2. Female- SBE, CBE, Mammography and Pap’s Smear
    • 3. Male- DRE for prostate, Testicular self-exam
  • 39. Nursing Assessment
    • Utilize the ACS 7 Warning Signals
    • CAUTION
    • C- Change in bowel/bladder habits
    • A- A sore that does not heal
    • U- Unusual bleeding
    • T- Thickening or lump in the breast
    • I- Indigestion
    • O- Obvious change in warts
    • N- Nagging cough and hoarseness
  • 40. Nursing Assessment
    • Weight loss
    • Frequent infection
    • Skin problems
    • Pain
    • Hair Loss
    • Fatigue
    • Disturbance in body image/ depression
  • 41. Nursing Intervention
    • MAINTAIN TISSUE INTEGRITY
    • Handle skin gently
    • Do NOT rub affected area
    • Lotion may be applied
    • Wash skin only with SOAP and Water
  • 42. Nursing Intervention
    • MANAGEMENT OF STOMATITIS
    • Use soft-bristled toothbrush
    • Oral rinses with saline gargles/ tap water
    • Avoid ALCOHOL-based rinses
  • 43. Nursing Intervention
    • MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy
    • Regrowth within 8 weeks of termination
    • Encourage to acquire wig before hair loss occurs
    • Encourage use of attractive scarves and hats
    • Provide information that hair loss is temporary BUT anticipate change in texture and color
  • 44. Nursing Intervention
    • PROMOTE NUTRITION
    • Serve food in ways to make it appealing
    • Consider patient’s preferences
    • Provide small frequent meals
    • Avoids giving fluids while eating
    • Oral hygiene PRIOR to mealtime
    • Vitamin supplements
  • 45. Nursing Intervention
    • RELIEVE PAIN
    • Mild pain- NSAIDS Moderate pain- Weak opiods
    • Severe pain- Morphine
    • Administer analgesics round the clock with additional dose for breakthrough pain
  • 46. Nursing Intervention
    • DECREASE FATIGUE
    • Plan daily activities to allow alternating rest periods
    • Light exercise is encouraged
    • Small frequent meals
  • 47. Nursing Intervention
    • IMPROVE BODY IMAGE
    • Therapeutic communication is essential
    • Encourage independence in self-care and decision making
    • Offer cosmetic material like make-up and wigs
  • 48. Nursing Intervention
    • ASSIST IN THE GRIEVING PROCESS
    • Some cancers are curable
    • Grieving can be due to loss of health, income, sexuality, and body image
    • Answer and clarify information about cancer and treatment options
    • Identify resource people
    • Refer to support groups
  • 49. Nursing Intervention
    • MANAGE COMPLICATION: INFECTION
    • Fever is the most important sign (38.3)
    • Administer prescribed antibiotics X 2weeks
    • Maintain aseptic technique
    • Avoid exposure to crowds
    • Avoid giving fresh fruits and veggie
    • Handwashing
    • Avoid frequent invasive procedures
  • 50. Nursing Intervention
    • MANAGE COMPLICATION: Septic shock
    • Monitor VS, BP, temp
    • Administer IV antibiotics
    • Administer supplemental O2
  • 51. Nursing Intervention
    • MANAGE COMPLICATION: Bleeding
    • Thrombocytopenia (<100,000) is the most common cause
    • <20, 000  spontaneous bleeding
    • Use soft toothbrush
    • Use electric razor
    • Avoid frequent IM, IV, rectal and catheterization
    • Soft foods and stool softeners
  • 52. Colon cancer
  • 53. COLON CANCER
    • Risk factors
    • 1. Increasing age
    • 2. Family history
    • 3. Previous colon CA or polyps
    • 4. History of IBD
    • 5. High fat, High protein, LOW fiber
    • 6. Breast Ca and Genital Ca
  • 54. COLON CANCER
    • Sigmoid colon is the most common site
    • Predominantly adenocarcinoma
    • If early  90% survival
    • 34 % diagnosed early
    • 66% late diagnosis
  • 55. COLON CANCER
    • PATHOPHYSIOLOGY
    • Benign neoplasm  DNA alteration  malignant transformation  malignant neoplasm  cancer growth and invasion  metastasis (liver)
  • 56. COLON CANCER
    • ASSESSMENT FINDINGS 1. Change in bowel habits- Most common
    • 2. Blood in the stool
    • 3. Anemia
    • 4. Anorexia and weight loss
    • 5. Fatigue
    • 6. Rectal lesions- tenesmus, alternating D and C
  • 57. Colon cancer
    • Diagnostic findings
    • 1. Fecal occult blood
    • 2. Sigmoidoscopy and colonoscopy
    • 3. BIOPSY
    • 4. CEA- carcino-embryonic antigen
  • 58. Colon cancer
    • Complications of colorectal CA
    • 1. Obstruction
    • 2. Hemorrhage
    • 3. Peritonitis
    • 4. Sepsis
  • 59. Colon cancer
    • MEDICAL MANAGEMENT
    • 1. Chemotherapy- 5-FU
    • 2. Radiation therapy
  • 60. Colon cancer
    • SURGICAL MANAGEMENT
    • Surgery is the primary treatment
    • Based on location and tumor size
    • Resection, anastomosis, and colostomy (temporary or permanent)
  • 61. Colon cancer
    • NURSING INTERVENTION
    • Pre-Operative care
    • 1. Provide HIGH protein, HIGH calorie and LOW residue diet
    • 2.Provide information about post-op care and stoma care
    • 3. Administer antibiotics 1 day prior
  • 62. Colon cancer
    • NURSING INTERVENTION
    • Pre-Operative care
    • 4. Enema or colonic irrigation the evening and the morning of surgery
    • 5. NGT is inserted to prevent distention
    • 6. Monitor UO, F and E, Abdomen PE
  • 63. Colon cancer
    • NURSING INTERVENTION
    • Post-Operative care
    • 1. Monitor for complications
    • Leakage from the site, prolapse of stoma, skin irritation and pulmo complication
    • 2. Assess the abdomen for return of peristalsis
  • 64. Colon cancer
    • NURSING INTERVENTION
    • Post-Operative care
    • 3. Assess wound dressing for bleeding
    • 4. Assist patient in ambulation after 24H
    • 5.provide nutritional teaching
    • Limit foods that cause gas-formation and odor
    • Cabbage, beans, eggs, fish, peanuts
    • Low-fiber diet in the early stage of recovery
  • 65. Colon cancer
    • NURSING INTERVENTION
    • Post-Operative care
    • 6. Instruct to splint the incision and administer pain meds before exercise
    • 7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage
    • 8. Manage post-operative complication
  • 66.  
  • 67. Colon cancer
    • NURSING INTERVENTION: COLOSTOMY CARE
    • Colostomy begins to function 3-6 days after surgery
    • The drainage maybe soft/mushy or semi-solid depending on the site
  • 68. Colon cancer
    • NURSING INTERVENTION: COLOSTOMY CARE
    • BEST time to do skin care is after shower
    • Apply tape to the sides of the pouch before shower
    • Assume a sitting or standing position in changing the pouch
  • 69. Colon cancer
    • NURSING INTERVENTION: COLOSTOMY CARE
    • Instruct to GENTLY push the skin down and the pouch pulling UP
    • Wash the peri-stomal area with soap and water
    • Cover the stoma while washing the peri-stomal area
  • 70. Colon cancer
    • NURSING INTERVENTION: COLOSTOMY CARE
    • Lightly pat dry the area and NEVER rub
    • Lightly dust the peri-stomal area with nystatin powder
  • 71. Colon cancer
    • NURSING INTERVENTION: COLOSTOMY CARE
    • Measure the stomal opening
    • The pouch opening is about 0.3 cm larger than the stomal opening
    • Apply adhesive surface over the stoma and press for 30 seconds
  • 72. Colon cancer
    • NURSING INTERVENTION: COLOSTOMY CARE
    • Empty the pouch or change the pouch when
      • 1/3 to ¼ full (Brunner)
      • ½ to 1/3 full (Kozier)
  • 73. Breast Cancer
    • The most common cancer in FEMALES
    • Numerous etiologies implicated
  • 74. Breast Cancer
    • RISK FACTORS
    • 1. Genetics- BRCA1 And BRCA 2
    • 2. Increasing age ( > 50yo)
    • 3. Family History of breast cancer
    • 4. Early menarche and late menopause
    • 5. Nulliparity
    • 6. Late age at pregnancy
  • 75. Breast Cancer
    • RISK FACTORS
    • 7. Obesity
    • 8. Hormonal replacement
    • 9. Alcohol
    • 10. Exposure to radiation
  • 76. Breast Cancer
    • PROTECTIVE FACTORS
    • 1. Exercise
    • 2. Breast feeding
    • 3. Pregnancy before 30 yo
  • 77. pathophysiology
  • 78. Breast Cancer
    • ASSESSMENT FINDINGS
    • 1. MASS- the most common location is the upper outer quadrant
    • 2. Mass is NON-tender. Fixed, hard with irregular borders
    • 3. Skin dimpling
    • 4. Nipple retraction
    • 5. Peau d’ orange
  • 79. Breast Cancer
    • LABORATORY FINDINGS
    • 1. Biopsy procedures
    • 2. Mammography
  • 80. Breast Cancer
    • Breast cancer Staging
    • TNM staging
    • I - < 2cm
    • II - 2 to 5 cm, (+) LN
    • III - > 5 cm, (+) LN
    • IV- metastasis
  • 81. Breast Cancer
    • MEDICAL MANAGEMENT
    • 1. Chemotherapy
    • 2. Tamoxifen therapy
    • 3. Radiation therapy
  • 82. Breast Cancer
    • SURGICAL MANAGEMENT 1. Radical mastectomy
    • 2. Modified radical mastectomy
    • 3. Lumpectomy
    • 4. Quadrantectomy
  • 83. Breast Cancer
    • NURSING INTERVENTION : PRE-OP
    • 1. Explain breast cancer and treatment options
    • 2. Reduce fear and anxiety and improve coping abilities
    • 3. Promote decision making abilities
    • 4. Provide routine pre-op care:
    • Consent, NPO, Meds, Teaching about breathing exercise
  • 84. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • 1. Position patient:
    • Supine
    • Affected extremity elevated to reduce edema
  • 85. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • 2. Relieve pain and discomfort
    • Moderate elevation of extremity
    • IM/IV injection of pain meds
    • Warm shower on 2 nd day post-op
  • 86. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • 3. Maintain skin integrity
    • Immediate post-op: snug dressing with drainage
    • Maintain patency of drain (JP)
    • Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon
  • 87. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • 3. Maintain skin integrity
    • Drainage is removed when the discharge is less than 30 ml in 24 H
    • Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks
  • 88. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • Promote activity
    • Support operative site when moving
    • Hand, shoulder exercise done on 2 nd day
    • Post-op mastectomy exercise 20 mins TID
    • NO BP or IV procedure on operative site
  • 89. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • Promote activity
    • Heavy lifting is avoided
    • Elevate the arm at the level of the heart
    • On a pillow for 45 minutes TID to relieve transient edema
  • 90. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • MANAGE COMPLICATIONS
    • Lymphedema
    • 10-20% of patients
    • Elevate arms, elbow above shoulder and hand above elbow
    • Hand exercise while elevated
    • Refer to surgeon and physical therapist
  • 91. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • MANAGE COMPLICATIONS
    • Hematoma
    • Notify the surgeon
    • Apply bandage wrap (Ace wrap) and ICE pack
  • 92. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • MANAGE COMPLICATIONS
    • Infection
    • Monitor temperature, redness, swelling and foul-odor
    • IV antibiotics
    • No procedure on affected extremity
  • 93. Breast Cancer
    • NURSING INTERVENTION : Post-OP
    • TEACH FOLLOW-UP care
    • Regular check-up
    • Monthly BSE on the other breast
    • Annual mammography

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