1. You are a home health nurse visiting Lisa, a first-time mother who is 2 weeks postpartum. You ring the doorbell twice. Lisa answers the door with Emma in her arms. The baby is screaming. You take the baby from her, sit down on the couch, and ask her how things are going. Lisa starts to cry. She says she feels awful and tells you that all of a sudden, her left breast started hurting. She is exhausted and feels like she is getting the flu. Emma is hungry, but Lisa can’t bear the thought of nursing her. Lisa is shivering, so you hand her a blanket. Thankfully her husband comes home for lunch, so you hand Emma to him. You take this time to exam Lisa’s breasts.
A. What are the clinical findings you would expect to find upon examination of Lisa’s breasts?
B. What should be included in the teaching plan that you would develop for Lisa?
2. Susan had her first mammogram at age 40. The mammogram revealed a solid lesion measuring 3 cm located in the 3:00 position in the left breast. Susan was stunned. She did all the right things. She breast-fed her children for 2 to 3 months each and she tried to remember to check her breasts monthly. She was a Caucasian, with small dense breasts and her only vice was cigarette smoking. Susan underwent a fine-needle aspiration biopsy, which revealed a fibroadenoma plus atypical hyperplasia. Susan was recommended to get a mammogram in 6 months as part of a “planned watchful waiting.” At her subsequent 6-month visit, the test revealed two additional lesions adjacent to the primary lesion. Susan underwent a lumpectomy to remove the three masses, which were all classified as fibroadenomas. Six months later, two new lesions were identified in the left breast and three were located in the right breast. After consultation with a vascular surgeon, Susan elected to have a bilateral mastectomy with reconstruction. She underwent a skin-sparing bilateral mastectomy and when the pathology results were in, the specimens contained proliferative masses with atypical, hyperplastic cells. The surgeon told Susan, “If you had waited another 6 months, we would be doing chemotherapy and radiation.” Susan was started on an antidepressant a month later and reconstruction was completed. Susan returned to the office for her annual MRI of her breasts.
A. What risk factors did Susan have that placed her at increased risk for developing breast cancer?
B. What is the nurse’s role in caring for women like Susan?
C. What nursing diagnoses are appropriate for Susan?
