Reference no: EM133918594

Patient Profile

S.H., a 38-year-old married female, goes to see her health care provider afterb noticing a lump in her left breast. She had two miscarriages (G2, P0). Her mother had breast cancer at age 65 and one sister was diagnosed with breast cancer at age 42.

Subjective Data

Felt a lump in her breast while showering a few days ago and it has not gone away

Ex-smoker, smoked one-half pack of cigarettes for three years; quit at age 21

Drinks one to two glasses of wine/day

Objective Data

Physical Examination

Temperature 98.2° F, pulse 84, respirations 16, blood pressure 118/72, oxygen saturation 99%
Height 5'6", weight 155 lb, BMI 25 kg/m2

A firm, nonmobile and nontender mass, larger than the size of a pea, is palpable in the upper, outer quadrant of left breast

Some swelling and tenderness palpable in left axillary nodes

Lungs clear

Diagnostic Studies

Mammogram shows dense breast tissue, some microcalcifications in both breasts, and a 5-cm mass in the upper, outer quadrant of the left
breast

Fine-needle biopsy shows infiltrating lobular carcinoma that is both estrogen- and progesterone-receptor positive

Sentinel node biopsy shows two positive lymph nodes

Collaborative Care

S.H. is diagnosed with stage IIB breast cancer. Based on the findings and her family history, S.H. decides to have a left modified radical mastectomy.

1. Why did S.H. have a fine-needle biopsy and a sentinel node biopsy?

2. What were S.H.'s risk factors for breast cancer?

3. Due to S.H.'s family history of breast cancer, what type of testing could S.H. have had done to identify her genetic risk for developing breast cancer?

4. Prior to her surgery, what nursing assessments and teaching would be important for S.H.?

5. Why are postoperative arm exercises important for patients who have a mastectomy or axillary lymph node dissection?

6. What is lymphedema and what are some measures to prevent or reduce it after S.H.'s surgery?

7. What are the priority nursing diagnoses for S.H.? 2 Actual/1 Potential (correct formatting and NANDA approved diagnoses)