Breast Conditions

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 16 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.
an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.
Resources
Readings
• Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
o Chapter 16, “Breast Conditions” (pp. 377–401)
This chapter explores the clinical presentation, assessment, diagnosis, and management of breast conditions. It also identifies special considerations for adolescents, pregnant women, and older women.
o Chapter 19, “Infertility” (pp. 443–465)
This chapter defines infertility and provides an overview of the female and male anatomy and physiology related to infertility. It also describes details of infertility assessments, including examination procedures and diagnostic testing.
o Chapter 28, “Gynecologic Cancers” (pp. 701–748)
This chapter explores a humanistic approach for diagnosing, treating, and managing patients with gynecologic cancers. It also examines factors that increase the risk of developing a gynecologic cancer.
• Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
o Chapter 7, “Care of the Woman with Reproductive Health Problems”
 “Care of the Woman with an Abnormal Mammogram” (pp. 330–333)
This section identifies methods for evaluating and treating women with abnormal mammograms. It focuses on referring patients for specialty care as well as providing education and support to patients.
 “Care of the Woman with Nipple Discharge” (pp. 396–399)
This section examines the presentation of nipple discharge in the absence of pregnancy and presents methods for assessment, diagnosis, and management.
Optional Resources
• Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved fromhttp://www.cdc.gov/women/
• National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved fromhttp://orwh.od.nih.gov/
• U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved fromhttp://www.womenshealth.gov/

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