Question 1: What other questions should the nurse ask about the breast pain?
i. Where exactly within the breast does the patient feel the pain?
ii. How long has the patient been experiencing the pain?
iii. Is there any pattern on the frequency of pain?
iv. How long does the pain last?
v. Have you ever had a mammogram? If yes, when was the last one performed?
vi. On a scale of 1-10, how can the patient rate the level of pain severity?
vii. How the pain affects the quality of life of the patient, i.e. sexual activity, work or sleep?
viii. Has the patient ever been involved in an accident or physical activity that would contribute to the breast pain?
ix. Has the patient been using some contraceptives or has there been a recent change in medication?
x. Has the patient had a previous breast physical treatment/ surgery?
xi. How the patient can rate the fitting tightness of their bra on a 1-10 scale.
Question 2: What are some of the causes of breast pain?
i. Cardiac causes which may result in chest pressure/squeezing pain
ii. Chest wall muscle pain that occurs from muscle spasms which are associated with stress/anxiety.
iii. Esophageal causes resulting in a burning pain
iv. Pneumonia would give rise to breast pain given that the chest area is still below the breasts
v. Inflamed cartilage or costochondritis
vi. Fibromyalgia affects muscles and can cause pain on any part of the body including breasts
vii. Pulmonary emboli caused by blood clots in the legs and its travel to the lungs thus the patient ends up assuming that the pain originates from the breasts
viii. Breast Cysts
ix. Medication with hormonal impacts
x. Previous breast surgeries
xi. Breast cancer
xiii. Poorly fitted bra
Question 3: Develop a problems list from the objective and subjective list?
Moderate ,dull, tenderness, and bilateral pain in the breast. Given that the origin of the pain is still unknown it results in generalization hence the treatment will begin after the clarification on diagnosis. However, pain management remedies are recommendable before patient diagnosis gets completed.
However, based on the patient age, and time period since the last menstruation the breast pain is most likely to be cyclical caused by hormonal changes associated to ovulation. Breast tenderness and pain are consistent symptoms of ovulation and considering that ovulation pain typically occurs two weeks before menstruation. Ovulation triggers hormonal release that results in breast tenderness and pain. At the same time, the breast pain may be due to various forms of contraception that may result in hormonal shifts.
Regular screening tests will be suggested as follow-ups should the problem persist.
Previously, the patient has been performing monthly breast self-examinations.
Question 4: what should be included in the plan of care?
The patient care should mainly include a diet and lifestyle change. Some of the suggestions may include;
i. Wearing a breast bra that is professionally designed to provide firm support.
ii. During exercises, it is advisable to wear a sports bra; recommended if an individual has sensitive breasts.
iii. Use of cold or hot compresses on breasts
iv. Reduce or eliminate caffeine use
v. During this period the patient should momentarily stop breastfeeding to establish if it was the primary cause of breast pain.
vi. Adopt a low-fat diet
vii. Use of self-relaxation therapy as it assists reduce anxiety associated with breast pain
viii. In extreme circumstances over the counter pain relievers like ibuprofen or acetaminophen can be prescribed. The only approved prescription for relieving breast pain is danazol.
ix. Consider keeping a journal to help in recording breast pain experiences and classification as either cyclic or noncyclic.
x. As part of a long-term care plan, the patient should consider reducing the alcohol intake as it may increase the patient’s risk of hormone-receptor-positive breast cancer.
xi. Breast cancer and this can get examined through biopsy in which a piece tissue gets tested for the presence of breast cancer. Also, the patient should visit a genetic counselor to perform a cancer risk assessment and genetics program to analyze multi-gene panels (Bruce et al., 2014).
Question 5: Based on the readings and the subjective and objective data, what is the most likely cause of breast pain for this patient?
i. Side effects of medication related to hormonal balance.
iii. Breastfeeding infections
iv. cyclical breast pain
v. Breast Cysts
viii. Previous cases of breast surgery
ix. Breast cancer