1. Before operation

(1) Fear and anxiety: fear of operation due to ignorance of the disease; Those who know the condition are caused by organ defect and disfigurement.

(2) malnutrition, which is lower than the body's requirement: the food intake is reduced due to loss of appetite; Cancerous consumption; Because sympathetic nerve excitation is dominant, it inhibits the movement of digestive tract and the secretion of digestive glands, resulting in loss of appetite.

(3) comfortable changes, pain: cancer cells invade the nerves.

2.

(1) Possibility of changes in vital signs: related to anesthesia and operation.

(2) Comfortable change, incision pain, limb discomfort on the surgical side: caused by surgery.

(3) Possibility of limb edema on the operation side: It is caused by poor lymph and venous blood return due to axillary lymph node dissection during operation.

(4) Skin integrity damage: caused by surgery.

(5) Lack of rehabilitation knowledge: due to lack of special education and limited education.

(2) Nursing measures

1. Before operation

(1) Provide various life care.

① instruct patients to eat high-nutrition, digestible food, pay attention to the color, smell and taste of food, increase patients' appetite, meet the nutritional needs of the body, and reserve energy to achieve the purpose of enduring surgery. ② Develop a good habit of defecation, keep the stool unobstructed, and give laxatives according to the doctor's advice when constipation occurs.

(2) preoperative preparation.

① improve relevant inspection. ② The operation of venipuncture is skillful, which protects the vein and relieves the pain of patients. Venous puncture is not suitable for the affected limb after operation. (3) make preparations for the skin in the operation area, especially the armpit. After cleaning it with soapy water, use sterile scissors to flatten the skin and cut off the armpit hair, then jump on talcum powder, tighten the skin, and shave it off with a skin preparation knife to avoid damaging the skin. Those who need skin grafting should also prepare for the skin donor area. (3) Strengthen health education and provide psychological support.

Because patients and their families are worried about the effect of the operation, and the economic burden is too heavy, they show anxiety and depression. Nurses in charge should care about and be considerate of patients, understand their psychological state, patiently listen to their complaints and give help, and introduce the information about the treatment progress and survival rate of breast cancer and the knowledge about diseases and operations to those who know their illness, so as to enhance their confidence in treatment. For patients with pain, the responsible nurse should contact patients more, establish a good nurse-patient relationship, provide a quiet and comfortable environment, cooperate with doctors to use sedative and analgesic drugs appropriately, improve patients' bad mood, ensure rest and sleep, and make the body in a state of undergoing surgery.

2. After the operation,

(1) Observe the changes of the disease closely. The patient was operated under continuous epidural anesthesia and intravenous anesthesia. After the operation, he should be given a supine position, and his blood pressure, pulse and breathing should be closely monitored. Give the patient a semi-recumbent position after he is awake and his vital signs are stable, so as to facilitate breathing and drainage, and avoid or alleviate limb edema at the operation side. Observe whether the wound dressing is dry. In the early stage, local negative pressure suction or chest band dressing and sandbag pressure were used to help skin graft adhesion to avoid subcutaneous hematocele and hydrops. Pay attention to whether the negative pressure drainage is unobstructed and the blood supply of the surgical limb.

(2) To prevent edema and dysfunction of limbs on the operation side. Avoid venipuncture on the surgical limb and raise it appropriately. Three days after operation, the patient began to help the patient move his upper limbs, starting from the elbow and gradually expanding to the shoulder. The exercise method is to eat, comb your hair, wash your face and climb the wall with your fingers to promote blood circulation in your limbs.

(3) Strengthen psychological care. Because breast cancer surgery affects patients' physical beauty, most patients are extremely depressed, showing irritability, inferiority and even lack of confidence in treatment. Nurses should not only actively communicate with patients and gain their full trust, but also adopt their most acceptable methods as far as possible, patrol frequently and talk more, introduce the necessity and importance of treatment, and educate the patients about the adverse reactions of chemotherapy and radiotherapy and the preventive measures of their complications.

(4) Assist in life care. After operation, the patient's self-care ability decreased during his stay in bed. The nurse in charge should give full help, partial assistance and support education according to Orem's self-care model to meet his self-care needs.

(5) diet care. The diet of postoperative patients is very important. In addition to increasing calories, protein, vitamins and inorganic salts should be added to promote tissue growth and wound healing.

(6) discharge guidance. Discharge guidance is one of the important contents of holistic nursing, which plays a certain role in helping patients understand and prevent diseases and promoting and restoring health. In nursing and treatment, patients should be educated on rehabilitation knowledge, including reasonable diet and functional exercise of limbs on the surgical side. Timely follow-up, regular chemotherapy and radiotherapy, record the treatment and nursing plan on the discharge medical record, and ask the family members to pay close attention to the patient's psychological and illness changes.