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NURS 6551 Breast Conditions Discussion
NURS 6551 Breast Conditions Discussion
Throughout a woman’s life, her breasts go through many
normal, healthy changes. However, patients do not always understand these
changes and often visit health care providers for treatment. When examining
these patients, you must be able to identify when a breast condition is the
result of a safe and normal physiological change and when it is the result of
an abnormal change requiring treatment and management. A diagnosis of a breast
condition resulting from an abnormal change can be devastating for women,
making emotional support as vital to women’s well-being as proper assessment,
diagnosis, and management. For this Discussion, consider how you might
diagnose, manage, and support the following two patients presenting with breast
conditions:
Case Study 1:
You are seeing a 60-year-old Latina female, Gravida 4 Para
3104, who is concerned about a thick greenish discharge from her left breast
for the past month. The discharge is spontaneous and associated with dull pain
and burning. Upon questioning, she also tells you that she breastfed all her
children and is currently not on any medications except for occasional Tylenol
for arthritis. Her last mammogram, 14 months ago, was within normal limits. On
exam, her left breast around the areola is slightly reddened and edematous.
Upon palpation of the right quadrant, a greenish-black discharge exudes from
the nipple. You note an ovoid, smooth, very mobile, non-tender 1 cm nodule in
the RUIQ at 11:00 5 cm from the nipple. No adenopathy, dimpling, nipple
discharge, or other associated findings. Her right breast is unremarkable. The
patient expresses her desire to proactively decrease her risk for developing
breast cancer.
Case Study 2:
You are seeing a 53-year-old African American female for a
lump she found in her right breast two weeks ago in the shower. Her last
mammogram was three years ago and she was told it was “benign.” She had two
breast biopsies at ages 32 and 34 in her right and left breasts, respectively.
At both times she had surgery for removal of fibroadenomas. She does not routinely
do breast self-exams. Her mother had a mastectomy for breast cancer at age 63,
and she heard that a paternal aunt had a breast removed for cancer when she was
in her forties. Both mother and aunt are alive and well today. It was
discovered on postmortem exam that her grandfather had prostate cancer.
Menarche was at age 15 and she is still having monthly menses. She is Gravida 4
Para 3104 with her first childbirth at age 31. She was on oral contraception
for 10 years, has no history of fertility treatments, and had a bilateral tubal
ligation after the birth of her last child at age 35. Past medical history is
noncontributory. She wants to know how likely it is that she will get breast
cancer. Physical exam reveals breasts are symmetrical with no dimpling,
retractions, or rash. Her right breast has a 2 cm non-tender, hard, fixed mass
at 3:00 6 cm from her nipple. Left breast is non-tender without masses. No
nipple discharge bilaterally. No anterior cervical, infra- or supraclavicular,
or axillary adenopathy.
To prepare:
Review Chapter 15 of the Schuiling and Likis text.
Review and select one of the two provided case studies.
Analyze the patient information.
Consider a differential diagnosis for the patient in the
case study you selected. Think about the most likely diagnosis for the patient.
Reflect on the appropriate clinical guidelines. Think about
a treatment and management plan for the patient. Be sure to consider
appropriate dosages for any recommended pharmacologic and/or nonpharmacologic
treatments.
Consider strategies for educating patients on the treatment
and management of the disorder you identified as your primary diagnosis.