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Name: Eileen Turner Pt. Encounter Number: 3

CC:
“Left breast lump”

○ HPI: 47 y/o female G0P0 presents to the office with 5 week history of a lump in the left breast. Pt reports she initially detected the lump during her monthly SBE. She waited until her next cycle to examine again, and the lump persisted. The lump is located in the upper outer corner of the breast. She states that nothing makes it better or worse, and she has not had any treatment up until this point. Denies pain, nipple discharge or recent trauma. No other associated symptoms. Last mammogram 18 months ago was normal. She has been prescribed COC for 15 years for irregular periods. Family history of breast cancer- pts mother deceased age 49 as a result. She is seeking additional testing and work up.

Medications: Levonorgestrel/Ethinyl Estadiol 0.15 mg/0.30mg orally daily for metrorrhagia, HCTZ 25mg daily in AM for HTN

Allergies: NKA

Medication Intolerances: none reported
Past Medical History:
HTN, controlled on HCTZ x 1 year
Metrorrhagia controlled on COC

Hospitalizations/Surgeries
Tonsillectomy as a child

Preventative Health:
Immunizations up to date
Screening mammogram 2 years ago BI-RADS Category 2-benign findings, calcifications noted bilaterally. Compliant with meds but does not regularly monitor her blood pressure.

Family History

Mother: deceased age 49 breast cancer
Father: HTN
No siblings

Social History
She completed her PhD and is currently employed as an elementary school principal. She lives alone, is not currently in a relationship and has no children. Pt reports she feels safe in her home in a gated community with neighbors whom she is friendly with. Denies tobacco, alcohol or recreational drug use.

ROS Student to ask each of these questions to the patient: “Have you had any…..”
General
Overweight but denies weight change or fatigue.
Cardiovascular
Denies.

Skin
Denies.
Respiratory
Denies.

Eyes
Wears glasses but otherwise denies. Gastrointestinal
Denies.

Ears
Denies. Genitourinary/Gynecological
Denies urinary issues.
Last PAP 2020, normal.
G0, P0
Not sexually active.
Takes oral contraception as above.
Nose/Mouth/Throat
Denies.
Musculoskeletal
Denies.
Breast
Performs monthly SBE. Lump outer corner of left breast as described above. Denies nipple discharge or pain. Neurological
Denies.
Heme/Lymph/Endo
Denies. Psychiatric
Denies. Reports feeling anxious regarding presenting problem.
OBJECTIVE
Weight 5’8” BMI 26.9 Temp 98.3 BP 128/74
Height 177lbs Pulse 78, regular Resp 14
General Appearance
Healthy-appearing adult female in no acute distress.
Skin
Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted.
HEENT
No palpable lymph nodes. Thyroid not palpable. Trachea midline.
Cardiovascular
S1, S2 with regular rate and rhythm. No murmurs, gallops or rubs.Pulses 3+ throughout. No edema.
Respiratory
Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally.
Gastrointestinal
BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly.
Breast
Left breast lump 2cm in diameter, +skin retraction 3 O’clock position, 1cm from nipple. No nipple discharge noted. No tenderness.
Genitourinary
Speculum exam performed, cervix without lesions.
No visible discharge or blood noted in vaginal vault.
Uterus anteverted, mobile and nontender. Adnexa nontender and palpable bilaterally.
Digital rectal exam with no mass, good sphincter tone.
Musculoskeletal
Full ROM seen in all four extremities as the patient moved about the exam room. No joint pain or tenderness on palpation.
Neurological
Alert and oriented x 4. Speech clear. Good tone. Sensation intact.
Psychiatric
Alert and oriented with appropriate mood. Judgement intact. Answers questions appropriately.
Lab Tests/Imaging
Aerobic culture of the breast-negative
Bilateral diagnostic mammogram-BIRADS Category 5-High, suspicion of malignancy
Left breast biopsy under ultrasound guidance-Left Ductal Carcinoma in Situ.

Assessment
o Include at least three differential diagnoses
o **Breast Abscess
o **Fibroadenoma
o **Fibrocystic breast disease
o *Left breast lump, neoplastic ▪ Provide rationale for each differential diagnosis o Final diagnosis—*Left breast ductal carcinoma in situ
▪ Pathophysiology of primary and rationale for choosing as final
Plan
o **discontinue oral combined hormonal contraceptive pill (CHC)
o **follow up in 3 months
o **refer to breast surgery
o **refer to genetic counselor
o **refer to oncology/radiation oncology
o Medications
o Non-pharmacological recommendations
o Diagnostic tests
o Patient education
o Culture considerations
o Health promotion
o Referrals
o Follow up

Sample Answer

Compelling correspondence is essential to the achievement all things considered but since of the changing idea of the present working environments, successful correspondence turns out to be more troublesome, and because of the numerous impediments that will permit beneficiaries to acknowledge the plan of the sender It is restricted. Misguided judgments.In spite of the fact that correspondence inside the association is rarely completely open, numerous straightforward arrangements can be executed to advance the effect of these hindrances.

Concerning specific contextual analysis, two significant correspondence standards, correspondence channel determination and commotion are self-evident. This course presents the standards of correspondence, the act of general correspondence, and different speculations to all the more likely comprehend the correspondence exchanges experienced in regular daily existence. The standards and practices that you learn in this course give the premise to additionally learning and correspondence.

This course starts with an outline of the correspondence cycle, the method of reasoning and hypothesis. In resulting modules of the course, we will look at explicit use of relational connections in close to home and expert life. These incorporate relational correspondence, bunch correspondence and dynamic, authoritative correspondence in the work environment or relational correspondence. Rule of Business Communication In request to make correspondence viable, it is important to follow a few rules and standards. Seven of them are fundamental and applicable, and these are clear, finished, brief, obliging, right, thought to be, concrete. These standards are frequently called 7C for business correspondence. The subtleties of these correspondence standards are examined underneath: Politeness Principle: When conveying, we should build up a cordial relationship with every individual who sends data to us.

To be inviting and polite is indistinguishable, and politeness requires an insightful and amicable activity against others. Axioms are notable that gracious “pay of graciousness is the main thing to win everything”. Correspondence staff ought to consistently remember this. The accompanying standards may assist with improving courtesy:Preliminary considering correspondence with family All glad families have the mystery of progress. This achievement originates from a strong establishment of closeness and closeness. Indeed, through private correspondence these cozy family connections become all the more intently. Correspondence is the foundation of different affiliations, building solid partners of obedient devotion, improving family way of life, and assisting with accomplishing satisfaction (Gosche, p. 1). In any case, so as to keep up an amicable relationship, a few families experienced tumultuous encounters. Correspondence in the family is an intricate and alluring marvel. Correspondence between families isn’t restricted to single messages between families or verbal correspondence.

It is a unique cycle that oversees force, closeness and limits, cohesiveness and flexibility of route frameworks, and makes pictures, topics, stories, ceremonies, rules, jobs, making implications, making a feeling of family life An intelligent cycle that makes a model. This model has passed ages. Notwithstanding the view as a family and family automatic framework, one of the greatest exploration establishments in between family correspondence centers around a family correspondence model. Family correspondence model (FCP) hypothesis clarifies why families impart in their own specific manner dependent on one another ‘s psychological direction. Early FCP research established in media research is keen on how families handle broad communications data. Family correspondence was perceived as an exceptional scholastic exploration field by the National Communications Association in 1989. Family correspondence researchers were at first impacted by family research, social brain science, and relational hypothesis, before long built up the hypothesis and began research in a family framework zeroed in on a significant job. Until 2001, the primary issue of the Family Communication Research Journal, Family Communication Magazine, was given. Family correspondence is more than the field of correspondence analysts in the family. Examination on family correspondence is normally done by individuals in brain science, humanism, and family research, to give some examples models. However, as the popular family correspondence researcher Leslie Baxter stated, it is the focal point of this intelligent semantic creation measure making the grant of family correspondence special. In the field of in-home correspondence, correspondence is normally not founded on autonomous messages from one sender to one beneficiary, yet dependent on the dynamic interdependency of data shared among families It is conceptualized. The focal point of this methodology is on the shared trait of semantic development inside family frameworks. As such, producing doesn’t happen in vacuum, however it happens in a wide scope of ages and social exchange.

Standards are rules end up being followed when performing work to agree to a given objective. Hierarchical achievement relies significantly upon compelling correspondence. So as to successfully impart, it is important to follow a few standards and rules. Coming up next are rules to guarantee powerful correspondence: clearness: lucidity of data is a significant guideline of correspondence. For beneficiaries to know the message plainly, the messages ought to be sorted out in a basic language. To guarantee that beneficiaries can without much of a stretch comprehend the importance of the message, the sender needs to impart unmistakably and unhesitatingly so the beneficiary can plainly and unquestionably comprehend the data.>

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