Perioperative Care in Nursing: A Breast Cancer Patient Case Study

This nursing assignment focuses on the perioperative care of a 38-year-old woman diagnosed with recurrent metastatic breast cancer. It outlines the three key phases: preoperative, intraoperative, and postoperative, detailing the nursing interventions and challenges in each stage. The preoperative phase emphasizes patient education, psychological support, and preparation for surgery, including necessary diagnostic tests and medication precautions. The intraoperative phase highlights patient safety, anesthesia considerations, and the facilitation of the surgical procedure. The postoperative phase addresses wound management, infection control, pain management, nutritional support, and psychosocial care, particularly for patients undergoing mastectomy and facing potential complications such as delayed wound healing and the impact of chemotherapy and radiotherapy. The assignment emphasizes the importance of specialized and patient-centered care plans for breast cancer surgeries, addressing the unique needs and challenges of patients in advanced stages of the disease. References to relevant research and clinical guidelines are included to support the discussion.

Running head: NURSING ASSIGNMENT ON PERIOPERATIVE CARE
Nursing Assignment on perioperative care
Name of the student:
Name of the university:
Author note:

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NURSING ASSIGNMENT ON PERIOPERATIVE CARE
Table of Contents
Introduction: 2
Preoperative Phase 2
Intra-operative phase: 3
Postoperative phase: 4
Conclusion: 6
References: 8

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Introduction:
This paper explains the journey of a 38-year-old woman diagnosed with breast cancer
explaining all the challenges incurred during the period of her treatment to her recovery. She
didn’t have any major medical issues in the past and kept well before diagnosed with recurrent
metastatic breast cancer. This is also known as 4th stage cancer, which has spread to the other
parts of the body like bones, lungs, brain, etc. The perioperative period begins when the patient is
informed of the need for surgery, includes the surgical procedure and recovery, and continues
until the patient resumes his or her usual activities. The surgical experience can be segregated
into three phases: (1) preoperative, (2) intraoperative, and (3) postoperative. The word
“perioperative” is used to encompass all three phases. The perioperative nurse provides nursing
care during all three phases (Arwert, Hoste and Watt 2012).
Preoperative Phase
The preoperative phase begins when the patient, or someone acting on the patient’s behalf, is
informed of the need for surgery and makes the decision to have the procedure. This phase ends
when the patient is transferred to the operating room bed. The preoperative phase is the period
that is used to physically and psychologically prepare the patient for surgery. The length of the
preoperative period varies. For the patient whose surgery is elective, the period may be lengthy.
For the patient whose surgery is urgent, the period is brief; the patient may have no awareness of
this period. Diagnostic studies and medical regimens are initiated in the preoperative period.
Information obtained from preoperative assessment and interview is used to prepare a plan of
care for the patient. Nursing activities in the preoperative phase are directed toward patient
support, teaching, and preparation for the procedure (Bunn, Jones and Bell-Syer 2012).

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It has to be understood in this context that the preoperative phase the task of preparing the
patient must begin with the laboratory tests and EKG tests that are carried out a couple of days
before the surgery. However, the most important nursing activity in the preoperative phase is the
patient education and motivational support. Before any severe any surgical procedure the
anxiety, fear and confusion can have a significant impact on the vital signs of the patient. It is
very important for the patient to be calm and collected before the surgery. Without proper
psychological preparation patients often go into shock or panic attack during the surgery, which
can a detrimental impact on the success outcome of the surgery. Hence, the nursing professional
will need to focus on educating the patients about the surgical procedure and reassure her on the
success rate and recovery timeframe of the entire thing. However, more than the psychosocial
support, at this stage the patients will need cautionary education regarding the dos and donts; the
patient must be educated about not consuming aspirin, ibuprofen, any other NSAID drugs or any
supplements containing vitamin E as well (Clough et al. 2010). On the day of the operation as
well, there is effective physiological and psychological management provided to the patient. The
patent should be psychologically prepared for the surgery and must give full consent to all the
activities that are going to be carried out in the surgery.
Intra-operative phase:
The intra-operative phase begins when the patient is transferred to the operating room bed
and ends with transfer to the postanesthesia care unit (PACU) or another area where immediate
postsurgical recovery care is given. During the intraoperative period, the patient is monitored,
anesthetized, prepped, and draped, and the procedure is performed. Nursing activities in the
intraoperative period center will focus on patient safety, facilitation of the procedure, prevention

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of infection, and satisfactory physiologic response to anaesthesia and surgical intervention. The
anaesthetic plan that will be given to the patient is a very important area of concern in this phase.
It has to be mentioned in this context that for the cancer patients, the anaesthetic modality can
lower the defences of the patient against the malignant neoplastic growth. That is the reason the
anaesthetic choice for the patient needs to be mild and free from any opioid derived products
(Forget et al. 2010)
Postoperative phase:
The postoperative phase begins with the patient’s transfer to the recovery unit and ends with
the resolution of surgical sequelae. The postoperative period may be either brief or extensive,
and most commonly ends outside the facility where the surgery was performed. For patients who
will remain in the hospital for an extended stay, the perioperative nurse may not provide care
beyond patient transfer to the PACU, where postanesthesia care nurses assume responsibility for
the patient. In an effort to better utilize nursing resources, many perioperative nurses, particularly
in smaller hospitals, have been trained in postanesthesia care and are assuming responsibility for
providing care in both the operating room and PACU. Care at home, if required, is delivered by
home healthcare nurses. The majority of operative procedures performed today are done on an
outpatient basis (Gottschalk et al. 2010).
For patients who undergo surgery in ambulatory surgery facilities, day surgery centers, or
office-based surgical settings where the expectation is that they will return home on the same day
they have surgery, it is not uncommon for the perioperative nurse to provide care for the patient
during all three phases. Nursing activities in the immediate postoperative phase center on support
of the patient’s physiologic systems. In the later stages of recovery, much of the focus is on

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reinforcing the essential information that the patient and other caregivers require in preparation
for discharge (Gustafsson et al. 2011).
The most important focus for this patient in the post operative phase will be surgical wound
management, infection control, malignancy response measurement, and psychological support. It
has to be mentioned here that wound management and healing is still an unprecedented sector in
case of the tumor biology. As the patient had been in the last stages of cancer, there are added
risks of additional co-morbidities and iatrogenic factors. In case of the cancer surgeries often the
patients are opted for radiotherapy for local regional control which can have a significant
negative healing effect, the pathophysiology for this is the local tissue fibrosis and the vascular
effects. And in case the patient is given chemotherapy, it can also have a severe detrimental
effect on the rapidly healing tissues of the surgical wound site. The risk of various infections are
also effectively higher in case of the cancer patients and the fact that the functional properties of
the antibiotics is somewhat altered is another key challenge for the surgical wound management
and infection control of the patient. As the patient in this case study had been 4th stage cancer
patients the chances of surgical wound healing complexities are high. In such condition the
patient can be provided a advanced wound healing therapies such as the hyperbaric oxygen
therapy along with the regular actinomycin D based infection control (Lacomba et al. 2010).
On a more elaborative note, it has to be mentioned that during mastectomy the blood vessels
supplying oxygen to the breasts are cut and hence it represents extreme issues during the healing
of the wounds and in case of the patients in this case as well, the delayed wound healing can be
further aggravated due to this persistent issue. Two medications that can be used by the
perioperative wound care nurse to facilitate better and faster wound healing free of risk of

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infection can be Avastin and Herceptin. Both of these targeted therapeutic agents are fact acting
and can help in wound healing effectively (Lowery et al. 2012).
Pain management is another very important aspect of care provided to the patients in the
PACU. the patients are generally provided severe pain management medications such as
corticosteroids are administered as the anaesthesia is starting to wear off, in acute pain morphine
is also administered. The drainage tube needs to be aseptically removed within 24 to 48 hours of
the surgery as well. Followed by pain management the next area of concern for the patients is
nutritional status (Remmers, Holtgräwe and Pinkert 2010). The patents will remain on a strictly
fluid based diet for the day of the surgery and the morning after, the IV will remain until the
patent is capable of taking food via the oral route. After the perioperative nurse sure that the
patent can tolerate solid food, the liquid diet will need to continue, post which light antioxidant
rich and vitamin C and A rich food will continue. Last but not the least the patient will need to be
provided psychosocial support to the patient, there are various external and internal factors that
might lead to anxiety and postoperative depression. In this condition the patients may be
provided the aid of cognitive behavioural aid and relaxation therapies and counselling to help her
cope with the process and attain faster recover (McNeely et al. 2012).
Conclusion:
On a concluding note, it can be mentioned that there are a myriad of different complexities
that are associated with the process of mastectomy or breast surgery. With the patient in this case
being in the 4th stage of cancer the impact of the surgery can be detrimental on the patient in
various areas including wound healing, infection control, pain management, nutritional status
and psychosocial issues. Along with that the assignment also discussed the different additional

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care that needs to be taken for an advanced cancer patients as well. Hence the importance of a
specialized and patient centred perioperative care plan is extremely crucial in the case of breast
cancer surgeries.

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References:
Arwert, E.N., Hoste, E. and Watt, F.M., 2012. Epithelial stem cells, wound healing and
cancer. Nature Reviews Cancer, 12(3), p.170.
Bunn, F., Jones, D.J. and Bell-Syer, S., 2012. Prophylactic antibiotics to prevent surgical site
infection after breast cancer surgery. Cochrane Database Syst Rev, 1.
Clough, K.B., Kaufman, G.J., Nos, C., Buccimazza, I. and Sarfati, I.M., 2010. Improving breast
cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Annals of
surgical oncology, 17(5), pp.1375-1391.
Early Breast Cancer Trialists' Collaborative Group, 2011. Effect of radiotherapy after breast-
conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of
individual patient data for 10 801 women in 17 randomised trials. The Lancet, 378(9804),
pp.1707-1716.
Forget, P., Vandenhende, J., Berliere, M., Machiels, J.P., Nussbaum, B., Legrand, C. and De
Kock, M., 2010. Do intraoperative analgesics influence breast cancer recurrence after
mastectomy? A retrospective analysis. Anesthesia & Analgesia, 110(6), pp.1630-1635.
Gottschalk, A., Sharma, S., Ford, J., Durieux, M.E. and Tiouririne, M., 2010. The role of the
perioperative period in recurrence after cancer surgery. Anesthesia & Analgesia, 110(6),
pp.1636-1643.
Gustafsson, U.O., Hausel, J., Thorell, A., Ljungqvist, O., Soop, M. and Nygren, J., 2011.
Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer
surgery. Archives of surgery, 146(5), pp.571-577.

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Heaney, A. and Buggy, D.J., 2012. Can anaesthetic and analgesic techniques affect cancer
recurrence or metastasis?. British journal of anaesthesia, 109, pp.i17-i28.
Lacomba, M.T., Sánchez, M.J.Y., Goñi, Á.Z., Merino, D.P., del Moral, O.M., Téllez, E.C. and
Mogollón, E.M., 2010. Effectiveness of early physiotherapy to prevent lymphoedema after
surgery for breast cancer: randomised, single blinded, clinical trial. Bmj, 340, p.b5396.
Lowery, A.J., Kell, M.R., Glynn, R.W., Kerin, M.J. and Sweeney, K.J., 2012. Locoregional
recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast cancer
research and treatment, 133(3), pp.831-841.
McNeely, M.L., Binkley, J.M., Pusic, A.L., Campbell, K.L., Gabram, S. and Soballe, P.W.,
2012. A prospective model of care for breast cancer rehabilitation: postoperative and
postreconstructive issues. Cancer, 118(S8), pp.2226-2236.
Remmers, H., Holtgräwe, M. and Pinkert, C., 2010. Stress and nursing care needs of women with
breast cancer during primary treatment: a qualitative study. European Journal of Oncology
Nursing, 14(1), pp.11-16.