What Should the Nurse Do?
Wanda, a 32-year-old female, seeks medical attention at the outpatient clinic due to concerns about her breast health. She describes experiencing cyclic breast pain and tenderness over the past 6 months, with occasional lumpiness and swelling, particularly in the upper outer quadrants of both breasts. No nipple discharge, skin changes, or axillary lymphadenopathy are reported. Recently diagnosed with fibrocystic changes, Wanda expresses worry about the persistence of symptoms. Her medical history is unremarkable, with no psychiatric issues, and she is not currently taking any medication. Vital signs—blood pressure (120/80 mm Hg), heart rate (78 bpm), respiratory rate (16 bpm), and temperature (98.6° F or 37° C)—fall within normal limits.
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Based on Wanda’s symptoms, how would you differentiate between cyclic breast pain associated with fibrocystic changes and pain that might raise concern for a more serious condition like breast cancer? What specific features of fibrocystic changes contribute to the cyclic nature of her symptoms?
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If Wanda’s symptoms were indicative of fibroadenomas rather than fibrocystic changes, how might her presentation differ? What diagnostic steps should be taken to confirm or rule out the presence of fibroadenomas, and how would the management plan vary?
3
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Considering Wanda’s symptoms and medical history, how would you rule out nonlactation mastitis, especially the periductal mastitis form? What specific aspects of her presentation might guide the diagnosis, and what steps should be taken in the diagnostic process?
Lisa is a 45-year-old female who presents at the breast cancer screening clinic for her routine mammogram. Lisa reports no specific breast-related symptoms but has a family history of breast cancer, with her mother being diagnosed at the age of 50. She is generally healthy, with no significant medical or psychiatric history. Lisa’s vital signs are stable, and she appears calm but expresses mild anxiety related to her family history and the screening process. Lisa’s mammogram reveals suspicious findings in her left breast, prompting further diagnostic evaluation. A subsequent biopsy confirms the presence of invasive ductal carcinoma. Lisa is shocked by the diagnosis and expresses a range of emotions, including fear, sadness, and uncertainty about the future.
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What specific risk factors for breast cancer should Lisa be made aware of based on her family history? How might these factors influence her ongoing screening and preventive measures?
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As a nurse, how would you address Lisa’s emotional responses, including fear, sadness, and uncertainty, following her breast cancer diagnosis? What supportive interventions could be implemented during this critical period?
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Based on Lisa’s diagnosis of invasive ductal carcinoma, discuss the potential treatment modalities that might be recommended for her. How would you explain these options to Lisa and involve her in the decision-making process?
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What specific nursing interventions would you implement in the postoperative care of Lisa, who underwent a mastectomy? How can you address her physical and emotional well-being during this recovery period?
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How can nurses actively engage in referring patients like Lisa and their support people to community agencies? What local resources might be beneficial for Lisa, considering her diagnosis and emotional needs?