The client underwent a right breast lumpectomy and axillary node dissection 2 months ago. The client is seeking treatment today for reports of an increase in the size of the right arm and a "tingly" sensation in the same limb. The client expresses concern, "I am going to be disfigured." The edges of the incision are well approximated, and no erythema or drainage is noted. There is no swelling or redness in the breast or axilla. The right arm has minimal swelling compared with the left arm. There is a strong right radial pulse and normal movement and sensation in both hands. Capillary refill time is less than 2 seconds in the right hand. The upper arm circumference is 46 cm (18 in) on the right and 44 cm (17.25 in) on the left. The client's body mass index is 30 kg/m2.
The nurse is planning care for this client. Which complication(s) is the client at risk for developing? Select all that apply.
A. toxic shock syndrome
B. cellulitis
C. uremic frost
D. lung cancer
E. altered body image
F. arterial ulcers
Answer (2)
The client is at risk for cellulitis due to the surgical history and altered body image stemming from concerns about appearance. Cellulitis is relevant due to potential infection, and altered body image is significant given the client's emotional state post-surgery.
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The client is at risk for cellulitis due to potential infection and altered body image related to concerns about appearance after surgery. Other listed complications are less relevant based on her specific symptoms. Monitoring and addressing these risks are essential in her care plan. ;
