Pre and Postoperative Management of MRM

This assignment delves into the comprehensive management of patients undergoing major reconstructive muscle (MRM) procedures. It emphasizes the importance of thorough pre-operative assessments, including detailed history taking and clinical examinations. The essay further outlines post-operative care protocols commencing in the recovery room, discussing pain management strategies like multimodal analgesia. It concludes by highlighting potential complications associated with MRM surgery and postoperative care.

Running head: PRE AND POST OPERATIVE MANAGEMENT 1
Pre and Post operative Management
Student’s Name
University Affiliation

PRE & POST OPERATIVE MANAGMENT 2
Introduction
Patients undergoing reconstruction of the breast after modified radical mastectomy
(MRM) can expect to experience lifestyle changes following the surgery. MRM is a procedure
involving the removal of an entire breast including all of its tissues (American Society of
Anaesthesiologists Task Force on Acute Pain Management, 2012). Historically, MRM was the
known main technique of treatment of breast cancer, and as the treatments have evolved, breast
conservation has been one of the most commonly used methods. Still, mastectomy is a good
choice for most people with breast cancer. During MRM, postoperative education is vital in
helping women cope with lifestyle changes as well as recover quickly following the surgery.
Preoperative care is the care provided prior to a surgical operation while the opposite is care
provided after surgery (Blaudszun et al., 2012). According to research, surgical patient who
believe that they did not receive adequate pre and post-operative education on management
experience dissatisfaction after a surgery and had difficulties in understanding the changes they
encounter. The rationale of this essay is to discuss preoperative and postoperative management
following a patient who is to undergo a bilateral total MRM and reconstruction of the breast
cancer. Clients and patients will be used interchangeably throughout the essay
Contraindications
There are few indications to the MRM. For clients with metastatic illness, the primary
mode of treatment is systemic therapy. Currently, MRM is not the primary care for people with
metastatic diseases (Chou et al., 2016). Other contraindications involve people who cannot
receive general anaesthesia.

PRE & POST OPERATIVE MANAGMENT 3
Preoperative Education
A patient with MRM encounters a life-changing event; hence it is critical to start the
education process in advance, especially in ambulatory setting before the surgery. Education at
this time can help the client to begin the process as well as prepare for the life changes prior to
hospitalisation rather than postoperative education while experiencing anxiety and pain which
cannot be helpful to the patient. Apart from the physician’s explanation of the diagnosis and
procedure, the client should have preoperative visits with clinicians to discuss the crucial
information regarding the surgical process, what to expect during surgery or in the hospital, skills
to be learned, and equipments to be used, as well as the necessary resource (Macintyre et al.,
2010). This kind of education can improve the patient’s outcome as well as gratification.
However, when providing preoperative education, you should first assess what the client knows
and the information he/she wants to learn to ensure that education is individualised and the
mutual objectives can be set. It would also be wise to include the patient’s family or friends in
education as shown plus based on clients’ preferences.
Best Practices
According to Chou et al., (2016) there has been a heated discussion over the presence of
lymph node dissection. However, modern indications for the first and second level of axillary
dissections in people undergoing mastectomy include; local axillary recurrence, outside clinical
trials, and failed mapping for sentinel lymph nodes biopsy among other indications. Clients need
to be assessed for lymph node dissection regularly. It should be known that axillary dissection
cannot be of great help to people with favourable tumour characteristics, multiple comorbidities
and the elderly.

PRE & POST OPERATIVE MANAGMENT 4
Procedure Planning
People who undergo MRM have a choice for immediate or delayed reconstruction with
antilogous implants or tissues. Before the procedure, the client should see a plastic surgeon
(Parvizi, 2011). However, the option for delayed or immediate reconstruction is reached in
regard to the need for post-mastectomy radiation as well as choice of surgeon.
Complication linked with MRM
Complications linked with MRM include problems linked with wound healing such as
chronic sarcoma, infection, hematoma, skin necrosis and dehiscence (Wu & Raja, 2011).
However, the risk of necrosis usually entails a greater flap plus the wound edges which is
commonly treated with wound care. However, people at high risks of postoperative problems are
those who are diabetic, smokers, those with a history of chest wall radiation. Following axillary
dissection as well as normal local healing problems, a change in the regional lymphatic system
puts the client in great danger. For those going through sentinel ‘lymph node biopsy’ before
axillary dissection, they are at risk of anaphylaxis linked with isosulfan contrast agent (White &
Kehlet, 2010). However, anaesthesiologists and clients need to be aware of such problems which
usually resolves intra operatively. People with completion axillary dissection have a greater risk
of contracting lymphedema and numbness under the axilla, hypersensitisation as well as chronic
pain in that region. According to Vadivelu et al., (2010), patients are encouraged to ambulate the
arm to prevent reduced shoulder function as well as scarring of the muscle to avoid cording and
chronic pain syndromes that can develop later on.

PRE & POST OPERATIVE MANAGMENT 5
Patient Preparation
Anaesthesia; anaesthesia should be used without neuromuscular blocking agents of the axillary
dissection and mastectomy. However, if a client is undergoing quick breast reconstruction
together with MRM, a paralytic can be used following completion of the dissection of the
axillary lymph node. Also, a thoracic paravertebral block is used to give procedural as well as
post-procedural analgesic effects thus resulting in declining in postoperative pain quickly and
after one day.
Positioning; clients need to be put on a table in a supine posture with their arm at a right angle
with the body.
Preoperative Nursing Management
Patient education; the nurse should teach the patient deep breathing plus coughing
exercises., encourage mobility as well as active body movement turning and foot and leg
exercise. Other education regimens would be teaching on how to manage pain plus cognitive
coping strategies (Macintyre et al., 2010).
Managing nutrition and fluids; the key role of withholding fluids and food before surgery can
help prevent aspiration. However, in such cases, a fasting period of eight hours is recommended
for meals that are fatty or fried.
Preparing for bowel procedure; enema is not ordered only when the patient is undergoing
pelvic surgery. Also, preoperative skin preparation can also be done to decrease bacteria without
injuring the skin.

PRE & POST OPERATIVE MANAGMENT 6
Quick preoperative nursing intervention; this can be done through administering pre-
anaesthetic drugs and maintaining preoperative records such as the consent form, final checklist
and identification
Postoperative Management
A study conducted at the University of Maryland showed that continuous infusion of
local anaesthetics after MRM leads to decreased analgesic consumption and has no influence on
the rates of vomiting as well as nausea. A control study involved 75 women who underwent
MRM, including 35 who got levobupivacaine for two days postoperatively via wound catheter as
well as 40 who received saline.
Nursing Management in the Post Anaesthesia Care Unit Abbreviated As (PACU)
Assessing the patient; regular assessment of a patients oxygen saturation pulse volume, as well
as regularity, skin colour, depth plus nature of respiration as well as the intensity of
consciousness, are some of the factors that should be considered in the PACU (Wu & Raja,
2011).
Maintain a patient airway is another function that should be considered in the unit. The
primary objective here is to maintain pulmonary ventilation as well as prevent hyperaemia and
hypoxia. The nurse’s role here is to apply oxygen as well as assess the reparatory rate/depth and
oxygen saturation.
Maintaining a cardiovascular stability; in this case, the nurse examines the client’s mental
status, cardiac rhythm, vital signs, skin temperature as well as colour/urine output. The central
venous pressure abbreviated as (CVP), pulmonary artery pressure (PAP) and the arterial lines

PRE & POST OPERATIVE MANAGMENT 7
should also be considered (Chou et al., 2016). The ain cardiovascular complications are shock,
hypertension, haemorrhage and dysarthria.
Assessing /maintain voluntary voiding; urine retention following surgery can occur due to
some reasons. Anaesthesia and opioids affect the perception of bladder fullness, and also the
abdominal, hip and pelvic might increase the probability of retention of secondary to pain.
Encounter activity; a vast number of surgical are encouraged to be awake most of the times.
This is because early ambulation lowers the chances of postoperative complications as
pneumonia, the circulatory problem as well as gastrointestinal discomfort to mention just safe.
Other nursing management in the PACU include relieving pain as well as anxiety, assessing plus
maintain the surgical state as well as evaluating and managing gastrointestinal function vomiting
and nausea are very common following anaesthesia
Postoperative Complications
Some complications can develop as a result of postoperative procedure; they include
Shock; this is the response of the body to a decreased circulation volume of blood, cellular
hypoxia as well as death plus tissue perfusion impairness (Blaudszun et al., 2012). Haemorrhage
is another complication where the blood escapes from the blood vessels. Deep vein thrombosis
abbreviated as DVT can also occur in lower extremities as well as pelvic vein and is very
common following hip surgery. Pulmonary embolism is the obstruction of one or more arterioles
by an embolus originating on the right side of the heart or in the venous system can also occur
alongside urine retention and intestinal obstruction which results in partial or complete
impairment to the forward flow of intestinal content (Vadivelu et al., 2010).

PRE & POST OPERATIVE MANAGMENT 8
Conclusion
This essay has reviewed pre and postoperative management for patients with MRM. It
draws attention to the main strays of this assessment where detailed history, as well as clinical
examination, needs to be conducted. Postoperative care commences immediately the procedure
has ended with the client being reviewed in the recovery room. Finally, MRM plus postoperative
analgesia has also been discussed showing the different complications that may arise due to
postoperative surgery

PRE & POST OPERATIVE MANAGMENT 9
References
American Society of Anesthesiologists Task Force on Acute Pain Management. (2012). Practice
guidelines for acute pain management in the perioperative setting: an updated report by
the American Society of Anesthesiologists Task Force on Acute Pain Management.
Anesthesiology, 116, 248-273.
Blaudszun, G., Lysakowski, C., Elia, N., & Tramèr, M. R. (2012). Effect of Perioperative
Systemic α2 Agonists on Postoperative Morphine Consumption and Pain
IntensitySystematic Review and Meta-analysis of Randomized Controlled Trials. The
Journal of the American Society of Anesthesiologists, 116(6), 1312-1322.
Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., ...
& Griffith, S. (2016). Management of Postoperative Pain: a clinical practice guideline
from the American pain society, the American Society of Regional Anesthesia and Pain
Medicine, and the American Society of Anesthesiologists' committee on regional
anesthesia, executive committee, and administrative council. The Journal of Pain, 17(2),
131-157.
Macintyre, P. E., Scott, D. A., Schug, S. A., Visser, E. J., & Walker, S. M. (Eds.). (2010). Acute
pain management: scientific evidence (pp. 35-45). Melbourne: ANZCA & FPM.
Parvizi, J., Miller, A. G., & Gandhi, K. (2011). Multimodal pain management after total joint
arthroplasty. JBJS, 93(11), 1075-1084.
Vadivelu, N., Mitra, S., & Narayan, D. (2010). Recent advances in postoperative pain
management. The Yale journal of biology and medicine, 83(1), 11.

PRE & POST OPERATIVE MANAGMENT 10
White, P. F., & Kehlet, H. (2010). Improving Postoperative Pain ManagementWhat Are the
Unresolved Issues?. The Journal of the American Society of Anesthesiologists, 112(1),
220-225.
Wu, C. L., & Raja, S. N. (2011). Treatment of acute postoperative pain. The Lancet, 377(9784),
2215-2225.