In addition to the degree of surgical resection and operation skills, correct functional exercise is an important element to ensure the functional recovery of the affected upper limb after radical surgery for breast cancer.
1.Specific steps of functional exercise of the affected upper limb
First stage.
Starting 24 hours after surgery, instruct the patient to do finger extension and fist clenching action to move the wrist joint. Do this 4 times a day, 10 times each time.
Second stage.
Two to three days after surgery, do forearm extension and flexion exercises, and practice elbow flexion and wrist flexion in sitting position. Do 10 strokes each time 4 times a day.
Stage 3.
4 to 5 days after surgery, practice touching the ipsilateral auricle and contralateral shoulder with the affected upper limb.
Fourth stage.
5 to 7 days after surgery, slowly straighten the affected upper limb, invert it, flex the shoulder joint and elevate it to 90 degrees.
Fifth stage: 7-10 days after surgery, practice finger “wall climbing” exercise until the affected side can lift the fingers high above the head and comb the hair by themselves.
2. Precautions in early functional exercise
In the following cases, it is necessary to delay the activity of the shoulder joint and reduce the amount of activity.
(1) Anyone who has axillary fluid accumulation and the flap does not fit adequately to the chest and axillary wall.
(2) Anyone with more axillary drainage on the 3rd postoperative day, greater than 60 ml/24 hours.
(3) Those with large area of necrosis of the flap in the near axillary area or implantation near the axilla.
3.Key points of care
The shoulder joint should be in the inward position within 48 hours after the operation, avoid abducting the upper arm, and extend the fingers and make fist movements. Use a sling to support the affected limb when getting out of bed, and only support the healthy side when supported by others to avoid sliding of the axillary flap and affecting the healing.
Guide and supervise the patient to carry out functional exercise correctly. Timely and accurate functional exercise is an important guarantee for the recovery of upper limb function. It is important to prevent excessive and violent movements from affecting the wound healing, and to pay attention to the movements that are not too small, so as not to affect the training effect. It is better to help the patient design an exercise schedule, record the daily exercise, and gradually increase the exercise movements and activities.
When increasing the movement, do not increase the amount, and when increasing the amount, do not increase the movement, step by step, to strive for the functional recovery of the affected upper limb as soon as possible, and finally achieve the functional exercise requirements, that is, the affected upper limb can touch the opposite auricle around the top of the head.
In addition to the basic care, nursing staff should also communicate with patients patiently, understand the psychological dynamics of patients in time, do a good job in psychological care and give patients psychological comfort. They should also introduce breast cancer treatment cases to patients to give them a personal account so that they can face the disease squarely and build up their confidence in life again.
The medical staff should formulate the functional exercise plan after discharge according to the different conditions of each patient, and instruct the patients not to measure blood pressure, draw blood, inject intravenously or lift heavy objects on the affected limb, and not to carry more than 5kg of weight on the affected limb, so as not to affect the recovery of the function of the affected limb.
Early functional exercise after breast cancer surgery is conducive to the venous reflux and outflow of drainage fluid of the upper limb after surgery, which is conducive to the decreasing of edema of the upper limb after surgery. Through early functional exercise, the incidence of complications such as subcutaneous fluid accumulation, blood accumulation, flap necrosis and severe edema of upper limbs can be significantly reduced. More importantly, early functional exercise reduced the occurrence of scar contracture, improved the functional recovery of the affected upper limb and the reconstruction of the patient’s self-care ability, enhanced the patient’s confidence in life, and improved the quality of life.