I Human Rachel Hardy; Breast Disorder case study Latest (may 2023). (COMPLETE plus Discussions)

I Human Rachel Hardy; Breast Disorder case study Latest (may 2023).(COMPLETE plus Discussions)
I Human Rachel Hardy; Breast Disorder case study
CC: “I can feel two lumps in my breast.”
HPI: R.H. is a 42-year-old female who presents with a chief complaint of two right-sided breast
lumps that were self-detected. Patient's mother was diagnosed with breast CA at age 48,
currently still living. Patient has a breast biopsy 3 years ago which showed atypical ductal
hyperplasia. Patient denies any breast pain, discharge, bleeding, skin changes, palpable lymph
nodes, or fevers. She reports a recent 11lb weight loss over the past 3 months due to unknown
cause. Physical exam shows 2 palpable breast masses, one 2.5cm mass in the upper quadrant of
the right breast, and another 2cm mass in the right breast. A right axillary lymph node that is
hard and mobile is also palpable.

Past Medical History
- Chronic idiopathic pancreatitis
- Hypothyroidism
- Atypical ductal hyperplasia

Past Surgical History
Pancreas sx last year

Social History
- Tobacco use: 1-pack year history
- Drug use: denies
- Alcohol use: 2 glasses of wine per day starting at age 18; quit 6 years ago
- Marital status: never married
- Current/previous occupation: disabled due to chronic pancreatitis
- Sexual orientation: female
- Sexually active: not sexually active for past 12 years
- Living situation: currently resides at home with 2 children
Family History
Mom- alive, breast CA at 48
Dad – alive, healthy

Allergies
No known drug allergies

Active Medications
Levothyroxine 25 mcg Q AM
Pancrealipase 15000 units 2 tab before each meal
Oxycodone 5mg 1 tab PRN Q4 pain
Amitriptyline 25mg 1 PO Q AM
ROS:
General: Patient denies fevers, weight gain or loss, loss of appetite, night sweats, fatigue, or
changes in sleeping.
HEENT: Denies double or blurred vision, photophobia, discharge from eyes, or vision loss.
Denies any abnormal nasal discharge, pain, or epistaxis. Denies hearing loss or tinnitus.
CV: Denies any chest pains, palpitations or racing heart, bounding pulses, or edema.
Respiratory: Denies any SOB, difficulty breathing, wheezes, or pain with inhalation/exhalation.
GI: Denies any abdominal pain, nausea, vomiting, diarrhea, constipation, melena, or
hematemesis.
GU: Denies dysuria, frequency, hematuria, pain, or discharge.
MS: Denies any new joint pains or swelling. Denies muscle pains, cramps, or weakness.
Skin: Admits to two palpable right sided breast lumps. Denies any rashes or petechia, discharge,
or abnormal pruritus. Denies any new skin lesions, or hair loss or increase.
Neurologic: Denies any double vision, problems with walking or balance, weakness, or fainting.
Psych: Denies memory loss, depression, agitation, suicidal thoughts, anxiety, mood swings, or
hallucinations.
Endocrine: Denies excessive thirst or urination, heat or cold intolerance, frequent
hunger/urination/thirst, or changes in sex drive.
Extremities: Denies pain or swelling, denies tingling or numbness to extremities.
Allergic/Immunologic: Denies seasonal allergies, hay fever symptoms, itching, or frequent
infections.

Vital Signs:
T: 98.4F PO
P: 72 bpm
BP: 116/68
RR: 16 bpm
O2: 98% RA
Height: 5’5
Weight: 149 lbs

Physical Exam:
• GENERAL: A pleasant Caucasian white female, alert and responsive, and appears
in no acute distress.
• INTEG: Skin appears warm, and normal in color and texture. No rash, pallor, or
icterus noted.
• LYMPH: Two palpable breast masses, one 2.5cm mass in the upper quadrant of the
right breast, and another 2cm mass in the right breast. A right axillary lymph node
that is hard and mobile is also palpable.
• HEENT: Head Normocephalic, atraumatic. PERRLA, EOMI noted. Ears clear with
normal tympanic membranes. Mucous membranes intact. Neck is supple without
any masses or adenopathy.
• CV: The external chest is normal in appearance without lifts, heaves, or thrills. S1,
S2 heard, no S3. No rubs, murmurs, or gallops auscultated. No edema present.
• RESP: Lungs clear to auscultation and percussion bilaterally in all lobes. No
adventitious lung sounds auscultated. No evidence of chest trauma noted.
• GI: Abdomen symmetric, soft and non-distended. Bowel sounds normoactive and
positive in all 4 quadrants with no bruits noted.
• NEURO: A&O x4. Motor strength is normal, 5/5 bilaterally to upper and lower
extremities. Sensation is intact bilaterally. Reflexes +2 bilaterally.
• PSYCH: Appropriate mood and affect. No visual or auditory hallucinations. No
memory loss, depression, or suicidal thoughts.
Labs/Diagnostics:
Mamogram: Abnormal, highly suspicious for breast cancer
Breast biopsy:
- Invasive duct carcinoma: estrogen-receptor positive; progesterone-receptor
positive; HER2/neu negative
- Right-axillary lymph node: metastatic breast adenocarcinoma
Diagnosis:
1. Breast mass/lump, neoplastic
Differential Diagnosis
Breast abscess
Fibroadenoma
Fibrocytic disease (breast cysts)
Breast lipoma
Fat necrosis
Phyllodes tumor

Plan
Non-pharmacologic: Referral to oncology specialist for possible surgical removal of breast
lumps, radiation, and medical management.
Pharmacologic: None at this time
Follow-up: In 2 weeks in primary care office after scheduled visit with oncologist specialist to
reassess recommendations.

NSG 6430 WEEK 4 DISCUSSION
iHuman Case Study – Rachael Hardy
Rachel Hardy is a 42-year-old woman presenting with a chief complaint of two right breast lumps that are constant and began 6 months ago. She reports a biopsy three years ago, which was negative for cancer. Rachel reports that her mother had breast cancer when she was 48 years old.
• Discuss the questions that would be important to include when interviewing a patient with this issue.