A. Characteristics of psychological changes when a healthy person suddenly becomes a cancer patient.
1. Anxiety and depression: nervousness, restlessness, irritability, sadness and crying, low speech and low voice, misanthropy, self-blame, and dullness.
2. Somatic reactions: sleep disturbance, headache, palpitations, increased blood pressure, increased heart rate, excessive skin sweating, increased frequency of urination and defecation, loss of appetite, etc.
At the beginning of hospitalization, the above-mentioned anxiety and depression manifestations are slightly lighter during the day, and the painful emotions are difficult to control at night. Some patients toss and turn in bed and have difficulty sleeping; some patients wander repeatedly in the hallway and refuse to go back to the ward; some patients inexplicably stand at the door of the nurses’ station and duty room and look around.
(1) The nurse should understand that this is an expression of the patient’s feelings of helplessness and loneliness, hoping for psychological comfort. They should not look at the patient with suspicion, let alone reprimand the patient or show a bored or indifferent expression, or give a sleeping pill.
(2) The patient should be asked about his or her feelings and needs, escorted to the bed, helped to make up the covers, and sat for a while in front of the patient’s bed, so that the patient can be comforted and a trusting relationship with the patient can be established from early on.
(3) What is the patient thinking? Patients associate from cancer to death, fear often evokes association with the past and future, consider future life family and career, causing patients to react negatively, heavy psychological pressure causes anxiety and depression, psychological care is very important at this time.
(4) Nursing measures to prevent patients’ bad mood: to prevent the dreary atmosphere in the tumor ward, you can use your medical knowledge to give systematic health education to breast cancer patients, invite anti-cancer stars to talk with patients and speak in person, so that patients can be in a group and reduce the sense of loneliness and misfortune, so that patients can feel that breast cancer is not mine alone, and build up confidence to fight with cancer, that others can do it, so can I. I am not worse than others. I am not inferior to others.
(5) In addition to the patient’s anxiety about the disease, the patient loses her role as a mother and a wife and becomes heavy-hearted. If you take time off from work at weekends to go home, take care of household chores, take on some obligations, feel the warmth of family, and appreciate your sense of responsibility and importance to others, it will enhance your confidence in treatment.
II. Pre-operative psychological care for breast cancer.
1. Patients’ attitude toward surgery: fear of pain and bleeding, loss of female beauty, loss of husband’s love and loss of family. Most patients have a strong desire to know about the upcoming surgery and want to know the treatment plan and specific steps they will get and how they can cooperate with medical treatment to reduce pain and recover smoothly.
2. Nurses can use different ways to inform patients about preoperative preparation, cooperation with anesthesia, cooperation with surgery, postoperative recovery process, explain how to cooperate with various medical activities, how to reduce pain and discomfort, and promote recovery by various coping methods, such as: abdominal breathing, bedside defecation, coughing and coughing methods, time and method of starting functional exercise after surgery, etc. The purpose is to enhance the patient’s confidence and sense of self-control, and lay the foundation for smooth postoperative recovery.
3. Methods to relieve preoperative anxiety: In addition to the above-mentioned care, you can ask the surgeon to give lectures, ask patients who have recovered well after surgery to present themselves, and ask patients to watch photos of the operating room environment, etc. According to the degree of anxiety, give appropriate amount of sedative drugs if necessary.
4. In the morning of the operation day, wish the patient a smooth operation and tell him/her that everything will go well for you as well as other patients, just a few words from the mouth of the medical staff will be a great comfort to the patients and their families.
Intraoperative psychological care
Breast cancer is different from other thoracic and abdominal tumors, once the radical surgery is completed, it is impossible to continue to hide the diagnosis from the patients. At this time, doctors and nurses in the operating room should not neglect the patients and talk to them to make them feel abandoned and cause resentment. They should accompany the patients and chat with them as much as possible to ease the tension and make them wait in a relaxed state of mind. Once the pathology result is positive, tell the patient that radical surgery is needed and promise her that we will carefully and seriously remove all the tumors and ask her to rest assured. Let her feel that there is a responsible collective helping her to fight against the disease and experience the friendly emotion of medical and nursing staff.
IV. Post-operative psychological care for breast cancer.
1. The patient’s mental tension has decreased and her emotional state has improved, indicating that the surgery can alleviate the patient’s life-threatening fear of cancer. However, when the first dressing is changed, especially when the relatively young patients face the miserable wound, they will develop self-pitying pessimism and resentment, pitying themselves for having an incurable disease, resenting themselves for having this disease, and even seeing it as the punishment of life to themselves. In a short period of time, because of aggression, resentment can make the patient’s character change greatly, the original cheerful, talkative people, may become silent, indifferent to people, the original gentle and reasonable people, become irritable, irritable, and even unreasonable.
2, at this time, the nurse should understand the patient with great compassion, comfort and educate the patient. Face up to the strong stimulus of physical disability causing the patient’s inner pain, encourage the patient to take the initiative to adjust their mindset, inform them that disability has become a reality, do not be drowned by inner pain, today’s suffering is in exchange for tomorrow’s health, have a tenacious spirit to overcome the disease and meet the future happy family life, should show their strong side in front of their parents adults and children. Psychological implication can stimulate the sense of responsibility: your family needs you, your husband needs you, your children need you, and you must cooperate with the treatment with a positive attitude to recover as soon as possible for the sake of your unfulfilled responsibilities.
V. Psychological barriers during breast cancer recovery.
1. Loss of second sex organ, fear of causing psychological barriers to sexual life. Physical defects, self-esteem is hurt, and fear of social difficulties.
2. After mastectomy, the wife is ashamed to expose her body because of her physical defects, and also fears that sex will have adverse effects on her disease recovery; while the husband will have a temporary discordant couple life out of care and restraint for his wife. The nursing staff should explain scientifically and objectively which aspect of the surgery affects women, and based on the empathy of the same women, inform the patients that mastectomy will not affect the normal couple life, the husband will make up for the love with more warmth and care, and after a period of psychological adaptation, the couple life will improve.
3. Regarding post-mastectomy shape defects, patients are instructed that they can wear suitable prosthetic breasts, and when their condition allows, they can also perform breast reconstruction. It does not affect normal social activities. Encourage patients to overcome the psychological inferiority complex, get out of the misunderstanding of self-pain, actively improve their self-image, and return to society and life and work in style.
VI. Pre-operative preparation.
Same as preoperative care routine for surgery.
Postoperative care
1.After awakening from anesthesia, take a lying position, suspend the affected limb with a triangular scarf, make the shoulder joint inward, and place the forearm in front of the chest to facilitate smooth drainage of the chest wall and axilla and prevent lymphoedema of the upper limb.
2.For 24 hours after surgery, the range of motion is restricted and the wrist and elbow joints can be moved.
3.After hours, the wound suture should be considered, and moderate activities should be performed under the guidance of doctors according to the different surgical styles.
4.For 7 days after surgery, the fluoroscopic patients are prohibited from shoulder joint abduction activities to avoid over-distraction of the wound, which may cause subcutaneous fluid accumulation.
5.More activities should be started after one week or after the drainage tube is removed. The nurse should explain that exercise of the upper extremity is necessary to prevent muscle atrophy, joint spasm, and restore muscle tone, and should be adhered to until 6 months after surgery.
6.Avoid blood collection, injection, infusion and blood pressure measurement from the affected upper limb.
7.Avoid wearing tight clothes, wearing tight hand ornaments and lifting heavy objects for too long to avoid poor circulation in the affected limb.
8. Observe the temperature, color and sensation of the affected limb, and explain the causes of arm distention, numbness and pain of the upper arm skin.
Eight, the care of common comorbidities
1, subcutaneous fluid: improper drainage tube position, untimely suction, too large trauma, premature extensor activity of the affected limb.
2, skin flap necrosis: skin flap is too tight, poor blood flow after stretching. Keep the wound clean, dry and prevent infection.
3, affected limb lymphedema: can occur 2 months after surgery and last 15-20 years. Large amount of lymphatic tissue removal and ligation of axillary vein branches lead to edema due to poor venous and lymphatic return of the affected limb. The affected limb should be elevated and massaged from the bottom up, centripetally for 30 minutes each time, protected by elastic bandages to avoid injury. Pneumatic therapy of the affected limb is also feasible to improve edema.
4. Functional rehabilitation of the affected limb: principle: practice finger joints, wrist and elbow activities on the first day after surgery. After three days, gradually increase the extension and flexion activities of the shoulder joint, and after 10 days, gradually increase the abduction activities of the shoulder joint.