Chapter Eighteen -Breast Lumps Mrs. R., a 40-year-old Hispan
Chapter Eighteen -Breast Lumps Mrs. R., a 40-year-old Hispanic… Chapter Eighteen -Breast LumpsMrs. R., a 40-year-old Hispanic woman, came to the health clinic today with her son. She speaks minimal English. She told her son’s wife that she found a lump in her right breast. Her son tells you that Mrs. R.’s sister, a curanderoa who lives in Mexico, had instructed Mrs. R. to eat certain foods and apply herbal poultices to her breast. As soon as he found out about the lump, he insisted that she visit the clinic. She reluctantly agreed. She has never had a mammogram and does not perform self-breast examinations; according to her son, she found the lump while bathing. Mrs. R. is alert but quiet, answering her son’s s softly. You do not speak Spanish. 1In this situation, who would best serve as an interpreter during the examination? Her son? What measures will enhance communication through this interpreter? 2What cultural aspects should you consider before beginning your interview and examination? 3What specific s should you ask Mrs. R. about pain associated with the lump? 4You found another nurse who can act as interpreter, and Mrs. R.’s son steps out of the room. At this point, you have the interpreter assist the patient with preparation for the examination and explain the procedure to her. After interviewing her, with the interpreter, you know the following:She first noticed this lump 4 months ago; she has not had any others. She has not noticed any change in the skin over the lump. It is tender to touch, and she says it hurts more immediately before her menstrual period. Her last period was 2 weeks ago. She denies any trauma to the breasts or any history of previous breast disease. She says that she is frightened because her sister died last year of breast cancer at 38 years of age; an aunt was treated for breast cancer 5 years ago. She had her first child at age 20, had 3 additional children during the next 10 years, and breastfed all of them. She is not sure how old she was when her menstruation started but thinks she might have been 11 years of age. She does not smoke or drink alcohol; she drinks two cups of coffee each morning.What risk factors does she have for breast cancer? 5When you perform the assessment of her breasts, you discover the following:The breasts are similar in size and shape and slightly asymmetric. The skin is smooth and even colored; no redness, bulging, or dimpling is noted. The nipples are symmetrically placed and point the same direction, with no retractions. There is no dryness, fissures, bleeding, or discharge from the nipples. When you ask her (through the interpreter) to raise her arms, the breasts move symmetrically. Other arm movements show no dimpling or puckering in the breasts. No nodes are palpable in the axillae.On palpation, the left breast feels soft and elastic. The right breast also feels soft, except for the lump in the lower right quadrant. The lump is located 3 cm from the nipple in the 8 o’clock position. It is round, lobular, and approximately 3 cm in width, 2 cm in height, and 3 cm in thickness. The lump is firm and rubbery to palpation, well demarcated, and mobile. The patient complains of tenderness when you manipulate the lump. You do not detect any additional lumps on palpation in the other quadrants of the right breast, the left breast, or the axillae.On the basis of your assessment do you think she has benign breast disease or breast cancer? Support your answer by citing the findings that support your diagnosis and findings that would need to be present to support the other diagnosis. What other diagnostic techniques are indicated? 6What teaching should be incorporated into your examination? Health Science Science Nursing NURSING BS NURS 221
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