SAMPLE
Reflect on a patient who presented with a breast condition during your Practicum Experience. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. Then, explain your patient education strategies for patients with or at risk of breast conditions. Include a description of how you might teach patients to perform breast self-examinations.
Galactorrhea
Women in health care often suffer breast issues and conditions. Nipple discharge is a breast symptom that will trigger women to seek medical council, which is the third most common reason why women seek care (Schuiling, & Likis, 2017). Galactorrhea not related to child bearing can be a pathologic discharge but if unilateral and clear or bloody can result in cancer (Schuiling, & Likis, 2017). Nipple discharge can be white, clear, yellow, green, or brown in color and must always be evaluated for malignancy if warranted (Schuiling, & Likis, 2017). Galactorrhea is a milky discharge that is bilateral and whom has not been pregnant or lactated in 12 months (Schuiling, & Likis, 2017). The cause is usually due to hyperprolactinemia due to pituitary prolactin-secreting tumors, medications, hypothyroidism, stress, trauma, chronic renal failure, hypothalamic lesions, previous thoracotomy, and herpes zoster (Schuiling, & Likis, 2017). Physical examination of breast should include palpation of both breast and lymph nodes with examination of nipple discharge and notation of color, consistency and number of ducts involved (Schuiling, & Likis, 2017).
34-year-old female presents to clinic with complaints white milky discharge to bilateral breast. Patient is Gravida 3 para 3, with last birth more than 3 years ago. No history of breast cancer or familial breast cancer. Tubal ligation performed after last pregnancy/birth. Patient does not take any medications at this time. Physical exam performed and visual abnormalities noted to breast other than milky discharge noted to bilateral nipples. Lymph nodes normal upon palpation. Patient stated that she noticed the discharge yesterday prior to visit in office. Thyroid palpation examination normal. Diagnostic test ordered during visit: urine pregnancy negative. Therefore, the following laboratory test were ordered and pending: serum prolactin level and thyroid stimulating hormone (TSH) (Schuiling, & Likis, 2017). If the patient is presenting hyperprolactinemia than an Magnetic resonance imaging (MRI) is warranted to rule out pituitary pro-lactin secreting tumor (Schuiling, & Likis, 2017). If patient does have a pituitary pro-lactin secreting tumor or elevated prolactin levels than patient would be started on dopamine antagonist such as bromocriptine to normalize prolactin levels or shrink tumor (Tharpe, Farley, & Jordan, 2017). If patient has hypothyroidism than thyroid replacement therapy is indicated. If galactorrhea persistent than refer to endocrine evaluation. If galactorrhea is idiopathic (normal prolactin levels and negative MRI) than no treatment is needed.
Patient was educated on importance of follow up to discuss laboratory findings and any referrals if needed. Patient was asked about any concerns or fears she might have related to her symptoms and risk (Tharpe, Farley, & Jordan, 2017). Patient also instructed on how to perform self breast examinations such as in the shower using finger tips and gently over breast feeling for hard knots or lumps; and in front of mirror looking for changes in contour of breast, changes in nipple, swelling or dimpling (Schuiling, & Likis, 2017). Patient instructed to report changes or increase in discharge to provider immediately.
References
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA:
Jones and 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.