NUR504- REPLY TO LORAINNE

Female Genitourinary & Musculoskeletal

As a clinician in one of the hospitals, it is first important for me to evaluate the information given by a patient before coming up with a diagnosis. In the case study provided, the patient complains of a tumor on her left breast and denies any chills or fever. However, to confirm her fears, I need to obtain more subjective information to correct the diagnosis. Such personal data may include whether the patient has noticed any changes in the lump’s size. Moreover, I would also want to know if she has noticed any thickening of the skin around her left breast, and if there has been any discoloration (Andsoy & Gul, 2014). The reason for obtaining this information is to diagnose the patient correctly. 

In terms of objective findings, I would examine if there has been puckering or dimpling of the skin around her left breast. I will also check if the lump has a different texture or appearance than the rest of the breast and axillary masses on her left breast (Andsoy & Gul, 2014). On the other hand, I would also assess if the patient’s bones are affected. Here, I would ask the woman whether she is experiencing joint pain or decreased sensitivity in her hands or legs due to low calcium levels. Finally, I would observe if the patient is experiencing extreme fatigue, swelling of the feet, or extreme abdominal girth. 

Once I have conducted and obtained both objective and subjective findings, the next step is to order various diagnostic tests. I would first order a biopsy test since it helps make a definite diagnosis compared to others. The test involves taking a small sample of tissue from the left breast for testing in the laboratory. It will help me confirm if some sample of the tissue taken is abnormal. The next test is conducting diagnostic mammography, which involves taking pictures of the affected breast, especially if the nipple has some discharge (Andsoy & Gul, 2014). Ultrasound is another diagnostic exam that I might order since it involves soundwaves to create an image of the breast tissue. It is essential since it distinguishes between a solid mass, cancerous, and a fluid-filled cyst, which may not be cancerous. Lastly, I will order an MRI test to use magnetic fields to produce detailed images of the body.

After conducting the diagnostic tests, I will evaluate different diagnoses based on the patient’s present symptoms. The first differential disease will be circumscribed breast lesions. It is a cancerous lump illness that affects the breast. Masses are made up of connective and glandular tissues that appear like a small, round sandstone in the breast. Circumscribed breast lesions are similar in breast cancer characteristics since the lump is moveable under the skin (Chalasani, 2020). The next differential diagnosis is benign breast disease, which comprises a cyst that grows in the breast milk duct (Chalasani, 2020). The tumor causes the breast to produce a discharge, leading to breast swelling and a lump behind or close to the nipple. Lastly, metastasis is another differential diagnosis that involves cancer cells spreading to other areas of the body. Metastatic cancer comprises soft, movable lumps that do not cause any pain but can be confused with breast cancer since they have similar characteristics.

Once I have evaluated differential diagnoses, the next step is to educate the patient on preventing and managing breast cancer. I will recommend the woman maintain a proper diet and exercise in the context of teachings often (Farma et al., 2017). I will also advise her to attend breast cancer screening regularly and do yearly mammogram screening.

References 

Andsoy, I. I., & Gul, A. (2014). Breast, cervix and colorectal cancer knowledge among nurses in Turkey. Asian Pacific Journal of Cancer Prevention, 15(5), 2267-2272.

https://doi.org/10.7314/apjcp.2014.15.5.2267 (Links to an external site.)

Chalasani, P. (2020). Breast cancer differential diagnoses. Medscape.

https://emedicine.medscape.com/article/1947145-differential (Links to an external site.)

Farma, K. K. F., Jalili, Z., Zareban, I., & Pour, M. S. (2014). Effect of education on preventive behaviors of breast cancer in female teachers of guidance schools of Zahedan city based on health belief model. Journal of Education and Health Promotion, 3, 77.

https://doi.org/10.4103/2277-9531.139240