RIVERSIDE CITY COLLEGE
SCHOOL OF NURSING
NURSING 21
N21 Fall 21 ANS Passport Study Guide - Focus Breast Disorder
Case Study, Chapter 58
Mrs. Martin is a 62-year-old patient who is seeking medical attention for a lump that she found in her right breast. Mrs. Martin lives
alone and has a 38-year-old son that lives in another state. She has a history of smoking 1 pack a day, and drinking alcohol, but had
stopped smoking 10 years ago. She reports drinking several glasses of wine per week. When asked about her physical activity and
exercise regime, she states that she is too busy to exercise. She works full-time and cares for her elderly parents. Her father has
advanced prostate cancer and is scheduled for a prostatectomy later this month.
Objective Data:
BMI 29
Height 5’ 7”
Menarche 13-years old
Menopause 57-year old
Family member with cancer
Skin intact, warm and dry, no breakdown; breast tissue
Vital signs – T 98.8, RR 18, HR 88, BP 110/78
Resp: Clear lungs to auscultation bilaterally
Card: Strong regular, S1 and S2
1. Enter the diagnostic procedures, current s/s, and medical history that are RELEVANT in the table below (list the diagnostic
procedures the PCP might order to assess the breast tissue)
Diagnostic Assessment, Labs and/or Rationale for Patient Instructions/Teaching
, Procedures Assessment/Lab/Procedures
1. Physical assessment, tissue Observe for: hard moveable/non- BSE best performed after menses starts (day 5-7) (day one is the first
palpation moveable mass (nodules), tender or day of the menses cycle).
non-tender, skin dimpling, erythema, PCP clinical breast exam should occur every 1-3 years between 20
breast/nipple changes in contour, and 39 years old.
orange peel appearance, thick skin,
unilateral localized venous patterns,
newly developed nipple inversion.
BSE instructions: while sitting raise both arms overhead then place
Assess for ulcers, rashes or
hands on waist and push in to elicit skin dimpling or retraction.
spontaneous nipple discharge. Ensures no mass to be missed. Abduct arms from thorax to examine
Check clavicular and axillary area axillary lymph nodes
for swelling, discoloration, Assess for contour changes in the breath as you move the hands in
lesions or enlarged lymph nodes. circular direction. When examining breast use 3 or 4 fingers to feel
Note lymph nodes that may be breast; start at the outer edge and using the flat part of the fingers
lying against the thoracic wall. check with small circular motion around breast - Assess for lumps or
Tumors tend to be hard, poorly masses - Contact your provider if you notice any discharge from
defined and nontender. breast Palpation
PCP will have the patient lie in supine position with a small pillow under
the shoulder to stabilize the breast tissue.
2. mammogram Breast imaging technique that is ACS recommends annual mammograms over age 40
used to visualize breast in order to Mammogram takes 15 minutes and can be performed in a hospital or
detect abnormalities indicative of an imaging center.
malignant or benign disease. Can Breast are compressed from top to bottom and side to side which
detect masses before they are may cause discomfort.
palpable (<1mm). Younger women or patients taking hormone therapy have denser
breast tissue which can make lesion detection more difficult.
Radiation exposure is same as 1 hour of sunlight exposure.
ACS recommends mammograms to be done every year beginning at
45, then women 55+ can get them every 2 years.
3. ultrasonography Used w/ mammography to Do not apply lotion to the chest wall the day of procedure. A
SCHOOL OF NURSING
NURSING 21
N21 Fall 21 ANS Passport Study Guide - Focus Breast Disorder
Case Study, Chapter 58
Mrs. Martin is a 62-year-old patient who is seeking medical attention for a lump that she found in her right breast. Mrs. Martin lives
alone and has a 38-year-old son that lives in another state. She has a history of smoking 1 pack a day, and drinking alcohol, but had
stopped smoking 10 years ago. She reports drinking several glasses of wine per week. When asked about her physical activity and
exercise regime, she states that she is too busy to exercise. She works full-time and cares for her elderly parents. Her father has
advanced prostate cancer and is scheduled for a prostatectomy later this month.
Objective Data:
BMI 29
Height 5’ 7”
Menarche 13-years old
Menopause 57-year old
Family member with cancer
Skin intact, warm and dry, no breakdown; breast tissue
Vital signs – T 98.8, RR 18, HR 88, BP 110/78
Resp: Clear lungs to auscultation bilaterally
Card: Strong regular, S1 and S2
1. Enter the diagnostic procedures, current s/s, and medical history that are RELEVANT in the table below (list the diagnostic
procedures the PCP might order to assess the breast tissue)
Diagnostic Assessment, Labs and/or Rationale for Patient Instructions/Teaching
, Procedures Assessment/Lab/Procedures
1. Physical assessment, tissue Observe for: hard moveable/non- BSE best performed after menses starts (day 5-7) (day one is the first
palpation moveable mass (nodules), tender or day of the menses cycle).
non-tender, skin dimpling, erythema, PCP clinical breast exam should occur every 1-3 years between 20
breast/nipple changes in contour, and 39 years old.
orange peel appearance, thick skin,
unilateral localized venous patterns,
newly developed nipple inversion.
BSE instructions: while sitting raise both arms overhead then place
Assess for ulcers, rashes or
hands on waist and push in to elicit skin dimpling or retraction.
spontaneous nipple discharge. Ensures no mass to be missed. Abduct arms from thorax to examine
Check clavicular and axillary area axillary lymph nodes
for swelling, discoloration, Assess for contour changes in the breath as you move the hands in
lesions or enlarged lymph nodes. circular direction. When examining breast use 3 or 4 fingers to feel
Note lymph nodes that may be breast; start at the outer edge and using the flat part of the fingers
lying against the thoracic wall. check with small circular motion around breast - Assess for lumps or
Tumors tend to be hard, poorly masses - Contact your provider if you notice any discharge from
defined and nontender. breast Palpation
PCP will have the patient lie in supine position with a small pillow under
the shoulder to stabilize the breast tissue.
2. mammogram Breast imaging technique that is ACS recommends annual mammograms over age 40
used to visualize breast in order to Mammogram takes 15 minutes and can be performed in a hospital or
detect abnormalities indicative of an imaging center.
malignant or benign disease. Can Breast are compressed from top to bottom and side to side which
detect masses before they are may cause discomfort.
palpable (<1mm). Younger women or patients taking hormone therapy have denser
breast tissue which can make lesion detection more difficult.
Radiation exposure is same as 1 hour of sunlight exposure.
ACS recommends mammograms to be done every year beginning at
45, then women 55+ can get them every 2 years.
3. ultrasonography Used w/ mammography to Do not apply lotion to the chest wall the day of procedure. A
