What should I recommend as a nurse for the diagnosis of this

What should I recommend as a nurse for the diagnosis of this patient?

Case study

Initial history:

62-year-old white, postmenopausal woman

Presents for annual examination after “call-back” on mammogram

State her breasts are cystic

History of 2- to 3- year use of hormone replacement therapy

Denies pain, nipple discharge, orskin changes of her breasts.

Additional history:

The patient does practice breast self-examination, but not routinely

Latest mammogram 2 years ago

Has noticed no changes in her breasts

Maternal grandmother was diagnosed with breast cancer at age 78

No previous breast biopsies

One child, age 34; has never breast-fed

No significant health history, no medications, exercises three times a week

Menarche at age 12, gave birth to first child at age 28

Physical examination:

Well-appearing,62-year-old, white female in no acute distress

Afebrile, vital signs stable

Weight stable at 150lbs, Height 5’4’’

HEENT:

Head examination normal

Neck supple, no JVD

No palpable cervical, supraclavicular, infraclavicular, or axillary adenopathy

Thyroid nonpalpable

Breast Examination:

Symmetric breasts

No dimpling, puckering, or nipple discharge

Skin appears normal

Diffuse, small mobile cystic nodules palpable in the upper outer quadrants of both breasts

Chest, Cardiac, Abdomen, Gynecologic:

Examination unremarkable

Additional findings:

Because “call-back”mammogram showed a new calcification, a diagnostic mammogram is ordered.This mammogram revels a 1.5-cm speculated mass irregular borders within the left upper outer quadrant of the left breast

During her examination, the radiologist informs you about the findings, and the patient agrees to undergo a core biopsy of thelesion

Results reveal an infiltrating ductal carcinoma

Additional information:

All laboratory test results and chest radiograph are normal

Breast surgeon educates patient about two surgical options including:

Lumpectomy with axillary dissection followed by local irradiation

Mastectomy with axillary lymph node dissection with or without reconstruction surgery

Patient and radiation oncologist discuss potential side effects of radiation therapy:

Acute changes such as skin changes (erythema and desquamation), lymphedema of the breast, and fatigue

Chronic problems such as rib fracture, breastretraction, scarring of lumpectomy incision, and the potential of pneumonitis

Treatment:

The patient elects breast conservation therapy (lumpectomy) and axillary dissection with RT

The pathology results reveal a 1.1-cm infiltrating ductal carcinoma

Graded II/III

None of the 12 lymph nodes is positive

All surgical margins are clear

ERs and PRs are positive

HER2/neu is negative

Stage IA

Patient elects treatment with the aromatase inhibitor anastrozole (Arimidex) only, followed by 6 weeks of radiation treatment because she had breast-conserving therapy

Following therapy, the patient will be followed every 3 to 4 months for the first 2 years, then every 6 months until 5 years, and then annually

Only routine yearly chest radiograph, routine chemistries, and mammography are ordered for follow-up, unless clinical suspicion for recurrence.

Solution

The patient is suffering from a tumor in the breast which can be either removed by Lumpectomyby removing the lymph nodes present in the breast or by removing the entire breast which is called as axillary dissection.The main thing is to ensure the patient comes back for regular checkups post surgery so that the formation of glands doesnt happen again.This will present any form of cancer from developing and keep the patient away from any breast cancer.The nurse should wear masks while assisting and make sure the patient is kept in isolation post surgery..