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Additional questions I would ask the patient regarding their breast mass (Smania, 2017): 

• Is the lump tender?
• Is it bilateral?
• When is her period due?
• Is it painful?
• Nipple discharge?
• How and when was the mass noted?
• Size change over time?

These questions would help determine if the lump was benign (fibrocystic changes) or malignant.  Fibrocystic changes are usually tender, bilaterally and may increase in size prior to menses. Pain, ample discharge and feeling the lump upon palpation requires further evaluation (Dunphy, 2015).

The exam should include ruling out infections that may cause breast a benign presentation of a breast lump. A detailed medical, surgical, medication, family and reproductive history should be taken, including any past hormone use. A clinical breast exam should be performed looking for nipple discharge, symmetry, inflammation, nipple retraction, visible masses or changes in skin texture and appearance. Findings should be documented in detail, such as thickening, nodularity, and asymmetry (Smania, 2017).

Differential diagnoses are as follows: mastitis, cellulitis, fibrocystic breast disease, and breast cancer (Dunphy, 2015). A diagnostic mammogram and ultrasound should be performed because the patient is over 30 years of age. If a simple cyst is found, aspiration should be performed only if the patient is symptomatic. If the aspirate is not bloody then the patient should be referred to a radiologist or surgeon for a biopsy. If a solid lesion is found, the patient should also be referred to a radiologist or surgeon for a biopsy (Smania, 2017).

I would recommend to the patient that they avoid chocolate, tea and coffee, wear a supportive bra and take 400 IUs of vitamin E daily until the test results come back (Dunphy, 2015). At this point, I would not feel confident prescribing any medications until I knew the pathology of the mass. Once diagnostics came back, I could prescribe if necessary according to the findings.

Most importantly, this patient needs reassurance and education about every step of this investigation. Never leave the patient guessing about what is coming next. That will only add to her anxiety. I would ask the patient to tell me all of her concerns and then address each one individually to help ease her worry about the unknown.

Dunphy, L. M. (2015). Primary Care: Art and Science of Advanced Practice Nursing - an Interprofessional Approach, DavisEdge. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780803694941/

Smania, M. A. (2017). Evaluation of common breast complaints in primary care. The Nurse Practitioner, 42(10), 8-15.