Nursing 6210 Patho Case Study 2
Question 1
Patient's Chief Complaints
"My breasts have been naturally cystic, but I have a new lump in my right breast that has
me concerned."
History of Present illness
G.S. is a 46 yo white, premenopausal woman who presents for her annual physical examination.
Approximately six weeks ago, the patient noticed a small, painless lump in the upper outer
quadrant of her right breast. At the time, she gave this observation little thought, assuming that
the lump was like the many others that she tends to develop around her menses. She states that
the lumps in her breasts become palpable and bothersome approximately 10 days before the start
of menstruation. At present, she is approximately four days from this start date. There is no
history of dysmenorrhea associated with her periods. However, the lump failed to resolve like
the others and seemed to get larger with time. The patient denies tenderness, pain, nipple
discharge, and skin changes in her breasts. She also denies any masses in the axillary region of
the right arm,
The patient practices breast self-exams, but not routinely. She has never had a mammogram.
Several years ago she had a breast biopsy that was consistent with fibrocystic changes. Her only
Pap smear was done two years ago and the result was normal.
Mrs. S. is married and the mother of three children—ages 3, 8, and 10 years. She breast fed all
three children. Her first full-term pregnancy occurred at age 35. She had been pregnant at age 15,
but terminated the pregnancy with an elective abortion. She has also suffered a first-trimester
miscarriage at age 20. She has had no pregnancies in which the delivery was conducted with
caesarean section.
The patient's menarche occurred at age 11 years and 1 month. She has taken oral
contraceptives for three years since the birth of her third child. Mrs. S. is the only child born to
her parents late in life (father was 45, mother was 42).
****THERE IS NOT A QUESTION ASSOCIATED WITH QUESTION 1 ****
Patient’s risk factors for breast cancer include:
- First full-term pregnancy at age 35, a woman’s age when her first child is born affects
her risk for developing breast cancer, the younger she is, the lower the risk.
- Race – whites have higher incidence rates after age 40
- Estrogen exposure – early menarche (before age 12), oral contraceptives
Concerns:
- Lump is painless
- Rapid growth
