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Sample Answer for NURS 6521 WEEK 6 JOURNAL ENTRY Included After Question
NURS 6521 WEEK 6 JOURNAL ENTRY
Week 6: Practicum Journal Entry
A Sample Answer For the Assignment: NURS 6521 WEEK 6 JOURNAL ENTRY
Title: NURS 6521 WEEK 6 JOURNAL ENTRY
NURS 6521 WEEK 6 JOURNAL ENTRY
Week 6: Practicum Journal Entry
Breast conditions are common in both lactating and non-lactating women and are caused mostly by infections, masses, and poor-latching in lactating women. The common breast symptoms that presented with a majority of female patients in the gynecological clinic included breast pain, masses, nipple discharge, cracked nipples, and color-change. Breast masses are classified as either benign or malignant. Breast masses are associated with women who had early menarche before 12 years, nulliparas, and those with late menopause of beyond 55 years. This journal entry will include a reflection of a patient who presented with a breast condition and a discussion of patient education strategies for patients with or at risk of breast conditions.
A 53-year-old Caucasian female patient presented to the gynecologic clinic with reports of having a felt a mass when conducting her monthly self-breast exam. She reported that the mass was on the left breast and was immobile. She had felt the mass for the past two weeks, which had aroused a lot of anxiety. She denied having breast pain, skin dimpling, nipple inversion, itchiness, or discharge. Menarche was at 15 years, and her menses had ceased at 50 years. She was a Para 3+0 and had no history of breast or gynecologic disorders. She was a known hypertensive patient with well-controlled blood pressure. Her maternal grandmother had breast cancer, and she was worried that she would end up in the same condition.
I conducted a thorough breast examination that revealed symmetrical breasts that had a normal appearance, normal breast skin color, and nipples with no discharge. On palpation of the right breast, there was no pain or tenderness, no masses or lumps. The left breast examination of the left breast revealed a firm round mass of 3 cm-diameter on the upper outer quadrant. There were no lumps noted or axillary lymphadenopathy.
I prescribed mammography, which revealed an encapsulated, well-defined mass that was interpreted as benign calcification. To ascertain the mammography findings, we recommended a fine needle aspiration biopsy of the breast mass. The patient was educated on how to take care of the biopsy site at home and to watch out for bleeding, swelling, or bruising. The biopsy test revealed that the mass was benign. The patient was then referred to a general surgeon for surgical review and excision of the mass.
The patient was recommended to have a mammography every two years to screen for breast malignancy. We advised her to conduct a monthly self-breast exam and report symptoms of breast pain, nipple discharge, breast masses, or lumps.
Patient Education Strategies for Patients with or At Risk of Breast Conditions
Individuals at risk of breast conditions include lactating women, postmenopausal women, women with a family history of breast conditions, and women who had early menarche (Ikhuoria & Bach, 2018). Patient education will entail educating women to conduct a monthly self-breast exam to assess for breast changes and the presence of lumps. In addition, I will recommend postmenopausal women to have a mammography done for the assessment of malignant breast masses (Coleman, 2017). The American Cancer Society (ACS) recommends annual mammography of women aged 40-44 years based on the potential benefits and risks to a woman (Smith et al., 2017). It also recommends yearly mammography for women aged 45-54 years
Lactating women should be taught proper breastfeeding by demonstrating to the woman how to position the baby when lactating, and the signs that she should look for to ensure that the baby is well-positioned and feeding appropriately. Teaching women on proper attachment can help prevent breast conditions such as cracked nipples, breast engorgement, and mastitis, which are common in lactating women. Moreover, teaching on personal hygiene, including maintaining breast hygiene, will help prevent primary skin infections such as breast abscess and cellulitis.
How I Might Teach Patients To Perform Breast Self-Examinations
I will teach both women and men how to conduct a self-breast exam since men are also at risk of developing breast cancer though they have a low risk compared to females. I will recommend premenopausal women to perform the exam after their menses to avoid misinterpreting the normal premenstrual breast symptoms for positive breast masses. The first step will involve inspecting the breasts, preferably in the mirror and assess the breast size, color, and shape (Anderson, Bevers & Carlson, 2016). It will also entail examining for breast sym[ptoms such as dimpling, bulging of the skin, swelling, redness, rash and nipple discharge or inversion.
The second step will be to examine the breasts by palpation using the hands’ finger pads and using the left hand to palpate the right breast and vice versa. I will advise patients to use circular motions to feel the breast tissue when lying down or standing. A pattern should be used that ensures the entire breast is examined by beginning from the nipple and palpating towards the outer breast (Anderson, Bevers & Carlson, 2016). Alternatively, one can palpate vertically from up and down and ensure that all the breast tissue has been palpated. Light pressure should be used for the skin and tissue beneath the skin, mild pressure for middle breast tissue, and firm pressure to palpate the deep tissues in the back and the axilla region (Anderson, Bevers & Carlson, 2016). Furthermore, I will educate patients to feel for masses and lumps. If a mass or lump is felt, they should note the shape, size, and if it is fixed or mobile. They should then seek medical consult for further examination and investigations.
Anderson, B. O., Bevers, T. B., & Carlson, R. W. (2016). Clinical breast examination and breast cancer screening guideline. Jama, 315(13), 1403-1404.
Coleman, C. (2017). Early detection and screening for breast cancer. In Seminars in oncology nursing (Vol. 33, No. 2, pp. 141-155). WB Saunders.
Ikhuoria, E. B., & Bach, C. (2018). Introduction to Breast Carcinogenesis–Symptoms, Risks factors, Treatment, and Management. European Journal of Engineering Research and Science, 3(7), 58-66.
Smith, R. A., Andrews, K. S., Brooks, D., Fedewa, S. A., Manassaram‐Baptiste, D., Saslow, D. Brawley, O.W., & Wender, R. C. (2017). Cancer screening in the United States, 2017: a review of current American Cancer Society guidelines and current issues in cancer screening. CA: a cancer journal for clinicians, 67(2), 100-121.