Nsg 6430 ihuman rachel hardey LATEST VERSION UPDATED 2023
Discuss the questions that would be important to include when interviewing a patient with
... [Show More] this issue.
This patient is a 42-year old female who came in today for examination of two lumps she has palpated on her right breast. She denies pain at the area of the lumps, denies nipple
drainage. She states that she had this condition approximately 3 years ago and a breast biopsy was done and she was diagnosed with atypical ductal hyperplasia. She is also complaining of not having an appetite and she has noticed a weight loss over the past couple of months. This patient does have a first relative family history of breast cancer. According to a study that was done at the University of San Diego California, Obtaining an accurate history is the critical first step in determining the etiology of a patient's problem ( University of San Diego, California, 2018). I prefer to use the OLDCARTS acronym to obtain a history.
O: When did you first notice the lumps in your breast? L: Where in your breasts are the lumps located?
D: How long have the lumps been there?
C: Are the lumps hard, soft, do they have rigid borders, are they movable? A: Are the lumps painful? If they are does anything make the pain better? R: Does anything make the lumps smaller or go away?
T: Is there a certain time of the month that they are larger? S: Are they painful?
Additionally, I would like to know when her last mammogram was and if she has had a pap smear done and were the results abnormal?
Discuss the clinical findings that may be present in a patient with this issue.
The clinical findings are positive for two lumps located in her right breast. The first mass is located at the 12 o’clock location and it is 2cm in size, the second mass is located at the 2 o’clock location is about 2.5cm in size. There is also a hard, although mobile, nodule located in the right axillary lymph node. This patient might have nipple discharge, and if so what does it look like, i.e.: blood, green, yellow, white etc. She had any trauma to the breast for example a car accident where the seat belt tightened against her breast. The breasts might be a difference of appearance such as increase or decrease in size. The nipple may be everted, pain may be present or absent and the mass may differ depending on the menstrual cycle (Pruthi, 2014).
Are there any diagnostic studies that should be ordered on this patient? Why?
This patient should have several diagnostic studies. A mammogram will depict the density of the soft tissue present. This study can detect a mass that is abnormal and may be suspicious of breast cancer it cannot give a definitive diagnosis. Many women who are premenopausal have breast tissue that appears dense.
A targeted ultrasound should be ordered, this will show if the mass is a solid mass, a mass of cystic consistency or a mixture of both of them. This test will also depict information on whether the margins of the mass are defined or not.
If a mass is suspected to be malignant the patient should have a magnetic resonance image (MRI) which will enhance the image and show masses that may be present that are not palpable.
Additionally, I would order a tissue biopsy to obtain histopathology on the mass to determine if it is malignant or not (Begum, & Kumar, 2018).
List the primary diagnosis and three differential diagnosis for this patient. Explain your reasoning for each.
The primary diagnosis I would use is neoplastic breast mass/lump. This diagnosis fits the description of the mass/lumps due to their duration of the lumps appearing 6 months
ago. Additionally, per Michael Saber, MD on the physical examination, the neoplastic breast mass will be palpable, obvious or subtle; the density soft, firm, or hard; mobile or fixed to the chest wall or skin; tender or nontender.
The differential diagnosis I would use are fibrocystic breast, lipoma and [Show Less]