Case Study #3

Discuss the different types of benign mass

Benign tumors are non-problematic masses that stay in the primary location without spreading to other parts of the body. Fibroadenomas, cysts, and lipomas are all examples of benign breast masses. Fibroadenomas are typical in young women and account for about 50 percent of benign breast masses for women under the age of thirty (Daly & Puckett, 2022). Fibroadenomas are composed of glandular and stromal tissue, which are non-tender, firm, rubbery and highly mobile. Surgery is usually not required unless if the mass is causing discomfort to the person, or for cosmetic reasons. Breast cysts present as a fluctuant, well-circumscribed, smooth round lesion, which may or not be tender. These breast cysts are usually composed of sacs full of fluid, are usually harmless and tend to disappear on their own. Lipomas are benign masses in the breast that are composed of soft tissue cells known as mesenchymal cells. These masses are soft and freely moveable. They should not cause any pain unless if they are nearby nerves, blood vessels, or joints.

Discuss how do you differentiate them

It is important to differentiate benign breast masses and rule out cancer. Aside from a thorough history and clinical breast examination, imaging studies and biopsies may be utilized together to determine the type of benign tumor. The management of benign breast changes includes clinical, radiological, and if necessary histological diagnostic investigations to rule out malignancy; palliation of symptoms; and counseling and monitoring of patients at increased risk of breast cancer (Stachs et al., 2019). Mammography, ultrasonography, or magnetic resonance imaging (MRI) can be performed to look at the mass's features and determine if it is solid or fluid filled. Fine needle aspiration (FNA) and core biopsy are two methods that can be used to retrieve a tissue sample from the bulk for microscopic analysis.

Discuss the different types of breast tissue sampling procedures done for these masses

Fine needle aspiration (FNA), core biopsy, and excision biopsy are all methods for obtaining tissue samples from the breast that can be used to diagnose benign tumors. The tissue sample for FNA is aspirated from the bulk using a very fine needle and evaluated for sample adequacy. The advantage of this device is the ease of use, while the disadvantages are the volume of tissue, lack of histopathologic data, and sensitivity (Versaggi & De Leucio, 2022). With a core biopsy, a bigger needle is used to retrieve a cylindrical core of tissue from the tumor. The benefits of this procedure are its cost-effectiveness, easiness, and ability to perform various biopsies of separate lesions within the same breast quadrant efficiently. To do an excision biopsy, a surgical procedure is performed to remove the entire mass with some of the surrounding tissue. Although this is invasive procedure, the risks of infection or hematoma are minimal.

Discuss the clinical presentations of malignant Breast Cancer

Malignant breast cancer can manifest clinically in various ways depending on its stage and subtype. Breast cancer tends to evolve silently; however, a lump or thickening in the breast, altered breast size or form, altered breast skin, and nipple discharge are all symptoms that may indicate cancer (Alkabban & Ferguson, 2022). Pain in the breasts, sores on the skin, swollen lymph nodes, and dimples on the skin are some of the additional symptoms that may appear.

An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.

To provide an accurate picture of a person's health and well-being, it is important to consider more than only their physiological parameters. Some examples of factors that should be considered and mentioned in a health assessment are relationships, social networks, employment, and economic situation. In addition, availability of services including medical care, traditions, customs of a particular culture, lifestyle choices, diet, exercise, and issues related to substance abuse are also important to be considered. For example, some cultures have set guidelines for their dietary intake, limiting their nutrition choices, and causing a detrimental effect on their health.

Name the different family developmental stages and give examples of each one.

            Families move through stages in a specific direction throughout time after members efficaciously master tasks for each stage. The first stage is independence when one enters adulthood without the financial, emotional, and social support of parents. The second stage is coupling or marriage in which two people in love unite via marriage or commitment and build their own family system. Stage three is the parenting stage in which a couple decides it is time to procreate and start their own family. Stage four is launching adult children, when children end up leaving the home. It starts off with the first child and ends with the last leaving the parents with an empty home, also known as empty nest syndrome. The fifth and final stage is the retirement stage, where the parents have completed all obligations of raising children, retired from work and can enjoy the successful result of years of hard work.

Describe family structure and function and the relationship with health care.

Family structure is the hierarchical organization of a family and the interdependencies among its members. It can refer to a wide variety of family structures, from the nuclear to the single-parent to the blended. The term family function is commonly used to describe the routine activities and obligations that a family completes together. One definition of a happy family is a group of people who can work together to solve problems, make choices, and provide emotional and practical support for one another.

Health care is intricately linked to family dynamics and dynamics within the family. In current health literature, family functioning is one of the main concepts explored with respect to the role of family in illness, and how illness impacts the family system (Zhang, 2018). Family members can often provide helpful information and support throughout the healthcare process. Their involvement in their loved one's health can go a long way toward promoting health and preventing sickness. However, family dynamics are not always a passive observer, and healthcare providers must consider family dynamics when treating patients. Addressing family stressors, supplying information and resources to promote healthy family functioning, and communicating with family members in a courteous and empathetic manner are all ways to achieve this goal.

Case Study 2

The majority of female infertility is due to ovulatory dysfunction and tubal and peritoneal pathology. The primary cause of tubal disease and tubal blockage is pelvic inflammatory disease (PID) (Schuiling & Likis, 2022). PID results in tubal scarring if it goes unrecognized and untreated. Delaying treatment for PID or having repeated episodes of PID can increase the risk of serious and long-term complications. Infertility related to PID is more likely to occur if chlamydia is the infectious cause, if there is a delay in treatment for PID, if the patient has recurrent episodes of PID, or if the cases of PID are severe (Jennings & Krywko, 2022). 

Although infertility is characterized by the failure to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse, R.T.’s medical history may be a contributing factor to her difficulties with conceiving. R.T. reports that she has been trying to get pregnant for about 7 months. For women older than age 35, evaluation and treatment of infertility are considered after 6 months of attempting pregnancy because fertility declines gradually beginning at age 32 (Schuiling & Likis, 2022). Evaluation should begin with a thorough history and physical examination. Obtaining relevant history and a semen analysis from her partner is also important, as poor sperm quality is a common cause for reduced fertility. They should be asked about any previous pregnancies, duration of infertility, frequency and timing of sex, STI history and about their lifestyle and habits. The basic diagnostic procedures that should be performed in an initial evaluation include documentation of ovulation detection and obtaining a semen analysis from the male partner (Schuiling & Likis, 2022). Infertility evaluation is an opportune time to suggest health-promoting behaviors that may specifically improve fertility such as achieving a BMI between 20-25, smoking cessation for both partners, and reducing alcohol and caffeine consumption. 

Due to the patient’s gynecologic history, the most presumptive diagnosis is ICD10 – N97.0 (Female infertility of tubal origin). The most common cause of blocked fallopian tubes is PID. Even if PID is no longer present, a history of PID increases the risk of tubal inflammation and scarring. Tubal blockage and damage can be diagnosed with a hysterosalpingogram (HSG) test. Differential diagnosis would include ICD 10 – N97.2 (Female infertility of uterine origin), N97.0 (Female infertility associated with anovulation), and N97.9 (Female infertility, unspecified). With results from diagnostic testing and procedures, a more informed diagnosis can be assigned. 

Throughout the treatment process, clinicians must be mindful of the physical health, mental health, financial resources, and overall well-being of the woman and her partner. The least invasive and least costly option should be offered as first-line treatment. For individuals presenting with anovulation, ovulation induction with time intercourse is often the appropriate initial treatment choice (Carson & Kallen, 2022). The oral ovulation induction agents used in infertility treatment are clomiphene citrate (Clomid), letrozole (Famara) and exogenous gonadotropins. The first-line medication for ovulation induction in women who do not have PCOS is Clomid, which is indicated for women who are anovulatory or have unexplained infertility (Schuiling & Likis, 2022). In the case of tubal infertility, for women with unilateral proximal tubal blockage, women may attempt conception with ovarian stimulation and intrauterine insemination (Carson & Kallen, 2022). However, when bilateral tubal obstruction exists, surgery to restore tubal patency or ovarian stimulation with in vitro fertilization (IVF) can be considered. IVF may also be indicated in cases of severe male factor infertility, failure of 3-4 cycles of ovulation induction, or in women older than 38 to 40 years (Carson & Kallen, 2022).  

An effective health assessment includes not only physiological data, but also psychological, sociological, spiritual, economic, and lifestyle factors as well. Subjective and objective data collection are an integral part of this process. To reach maximal health potential on individuals, a thorough assessment can identify current and future care needs of the patient. Incorporating all of these parameters into the health assessment allows the healthcare provider to plan and deliver appropriate, individualized care to the patient.  

The life cycle of the family is the process and stages that a family typically goes through. Each stage of family development shows a different level of responsibility and is used as an indicator of the role of someone in the family. The family developmental stages are as followed: 

· Family founding: establishing a home, becoming emotionally independent of parents, working out ways of handling differences, and learning homemaking skills (Niverthy, 2021). 

· Childbearing: learning about pregnancy, childbirth and children, gaining understanding of new husband-wife relationship, developing philosophy of child rearing, accepting responsibilities of parenthood, and understanding the role of grandparents (Niverthy, 2021). 

· Child rearing: continuing to learn about children, adjusting financial plans and housing to meet needs of children, assuming responsibility for school and community betterment, and becoming alert to particular needs of children at different ages (Niverthy, 2021). 

· Child launching: discarding folklore about love and marriage, gaining insight and knowledge to help children, enlarging child’s vocational choice by learning about new opportunities, giving emotional support to children as they leave home for work, military service, school or marriage, releasing children to live their own lives (Niverthy, 2021). 

· Empty nest: Adjusting to life as a couple after years as parents, accepting the reality of your life’s accomplishments, learning about modern methods of child rearing to improve skills as grandparents, preparing for and adjusting to retirement, and preparing for living alone (Niverthy, 2021). 

Family structure and functions influence the lives of its individual members. Family members influence one another’s health beliefs, practices, and status. The family’s structure, functioning, and relative position in society significantly influence its health and ability to respond to health problems.

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