S.H., a 38-year-old married woman, goes to see her health care provider after noticing a lump in her left breast. She had two miscarriages (G2, P0). Her mother had breast cancer at age 65 years, and one sister was diagnosed with breast cancer at age 42 years.
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 3 years; quit at age 21 years
Drinks one to two glasses of wine/day
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
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
S.H. receives a diagnosis of stage IIB breast cancer. Based on the findings and her family history, S.H. decides to undergo 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. Because of 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. Before 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.?
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