Patients presenting with breast conditions often possess similar anxieties related to breast cancer. While some of them know about the necessity of performing self-examinations, many women do not know how to distinguish regular changes of the breasts from unhealthy developments. In the discussed case, a 24-year-old woman came into the office after she had found a lump in her breast. Here, it is vital for a nurse to support the balance between assessing a patient’s condition and making sure that they are not discouraged for their attentiveness to their health. Thus, education strategies should be encouraging and simple, based on visual aids and helpful resources.
Patient’s Case
The patient is KB, a 24-year-old female who reported that she had recently noticed a small lump in her left breast. She stated that she did not have any other problem and did not have any pain or discomfort, but that she was worried about its causes. Her medical history did not reveal any chronic conditions, serious surgeries, or acute issues. Moreover, KB did not have any close relatives who had breast cancer.
The patient’s physical examination revealed a small (around 1/3 inch) smooth round mobile lump in the lower left section of her left breast, suggesting that KB likely had a fibroadenoma. It is a benign condition that often occurs in young women from 15 to 35 years old (Nassar et al., 2015). An ultrasound was ordered to investigate further, and the diagnosis of fibroadenoma was confirmed (Schuiling & Likis, 2017).
As fibroadenomas do not require treatment in most cases, the woman was not prescribed with any medication. Furthermore, KB decided that she did not need to remove the lump surgically – she was advised to document changes after regular breast exams and return to the clinic in case of new concerns.
Patient Education Strategies
In this case, the patient was aware that self-examination is a necessary part of healthcare. However, she performed such procedures occasionally and did not document any results for future comparison, relying only on her memory. An educational strategy for this and other patients can help them in creating a simple system of regular checks and information records (Tharpe, Farley, & Jordan, 2017).
For example, a pamphlet that describes all steps of the self-examination can be shown and distributed to patients. Organizations such as Breastcancer.org offer easy to understand articles that discuss all procedures and steps needed for an examination (“Breast self-exam,” 2018). A clinician should recommend the patient to consult this and similar reputable sources.
The teaching includes four main steps; in the first one, the exam is performed standing in front of the mirror. The nurse describes that the patient should assess the size, color, and shape of breasts when looking at them and note any changes. Then, the patient raises her arms and looks at the breasts again. Next, the patient lies down and uses the right hand to examine the left breast and vice versa. The woman should keep her fingers together and use the first finger pads, moving them in a circular motion from the nipple. She can also move the fingers up and down – a comparison of this procedure to the work of a lawnmower may help.
The pressure of the fingers should vary for different areas – deep tissue requires some firm pressure, while the tissue beneath the skin is easily palpable. In the final step, the woman should stand up again and feel her breasts similarly with the other arm raised.
Conclusion
The case presents a woman who has performed self-examinations occasionally and knows that changes should be assessed by a clinician. Here, patient education should focus on encouraging the patient to continue her practices and adopt a schedule to make the exams a regular procedure and a part of her healthcare. In some situations, patients are not aware of what conditions are considered anomalous. Nurses can use visual and digital resources to help patients adopt self-exams into their routine.
References
Breast self-exam. (2018). Web.
Nassar, A., Visscher, D. W., Degnim, A. C., Frank, R. D., Vierkant, R. A., Frost, M.,… Ghosh, K. (2015). Complex fibroadenoma and breast cancer risk: A Mayo Clinic benign breast disease cohort study. Breast Cancer Research and Treatment, 153(2), 397-405.
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.