NURS 6551:Week 6: Common Gynecologic Conditions, Part 3 Essay Assignment Paper

—Betsey Johnson, breast cancer survivor, advocate, and fashion designer

Breast conditions are among the most common gynecologic conditions, and an estimated 290,000 women are diagnosed with breast cancer each year (American Cancer Society, 2012). Carla Hickey, a 36-year-old mother of three, was one of these women. After finding a lump in her breast, Hickey scheduled a mammogram with her health care provider. The mammogram and additional diagnostic testing confirmed that the breast condition was stage II breast cancer. While Hickey was struggling to cope with the psychological impact of her diagnosis, her mother was also diagnosed (MD Anderson Cancer Center, 2012). While a family history of the condition may be a risk factor as it was in Hickey’s case, 85 percent of women diagnosed with breast cancer have no family history (Breastcancer.org, 2012). In your role as the advanced practice nurse, you can educate and support women by helping them understand their individual risks and encouraging preventive care.

This week, as you continue exploring common gynecologic conditions, you examine strategies for diagnosing, treating, managing, and educating patients with breast conditions such as breast cancer. You also consider sociocultural factors that might impact the care of women with or at risk of these conditions.

Learning Objectives

By the end of this week, students will:

• Assess patients with breast conditions
• Evaluate differential diagnoses for breast conditions
• Analyze treatment and management plans for patients with breast conditions
• Analyze strategies for educating patients on the treatment and management of breast conditions
• Evaluate the impact of sociocultural factors on the treatment and management of breast conditions
• Understand and apply key terms, principles, and concepts related to common gynecologic conditions
• Evaluate breast conditions in patients

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.

 

• • Chapter 15, “Breast Conditions” (pp. 357-374)

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.

 

• • Chapter 18, “Infertility” (pp. 419-440)

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.

 

• • Chapter 27, “Gynecologic Cancers” (pp. 655-694)

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. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

 

• • Chapter 7, “Care of the Woman with Reproductive Health Conditions”

 

• • • “Care of the Woman with an Abnormal Mammogram” (pp. 360-364)

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. 422-424)

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 from http://www.cdc.gov/women/

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/

Discussion: Breast Conditions

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.

By Day 3

Post 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.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Explain how sociocultural factors might impact the diagnosis, management, and follow-up care of patients with the disorder your colleagues discussed.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously.