NSG 5003 Week 2 Discussion2 Betty Burns

NSG 5003 Week 2 Discussion2 Betty Burns NSG 5003 Week 2 Discussion 2 Betty Burns Betty Burns

After completing your iHuman Case Study, answer the following questions:

 What is your list of appropriate differential diagnoses and why?

 Disk herniation: Betty’s foot drop with weakness and pain located in the

particular area of her lower back can occur in someone who has disk herniation. Her pain overlies the lumbar spine and she has paraspinal muscular spasms and tenderness.

 Tuberculosis: This should be ruled out based on her positive PPD.

Sometimes there can be false positives but it should still be followed up on to make sure she does not have skeletal tuberculosis. This accounts for 35% of TB cases. Breast metastasis: The liver is a potential site for breast cancer mets along with other symptoms. What is the final diagnosis, and what assessment findings serve to support this? Breast cancer metastasis is the final diagnosis. Betty has fatigue, unexplained weight loss, and night sweats. Although these symptoms are not specific to her initial complaint of back pain, they should be considered in someone who has a history of breast cancer as well as a familial history.The patient also still has 1 breast and has the potential to get breast cancer again. According to i-human (2018), bone is the most common place for breast cancer to metastasize with pain being the most common presenting symptom. Discuss normal versus abnormal findings. Betty has constant back pain that occurred while doing an everyday activity, picking up laundry. She also has a palpable liver edge of 3cm, normally the liver is not palpable which is concerning. She experiences discomfort with light palpation on her vertebrae (L3 to L5). Imaging confirms L4 compression fracture which is also abnormal. Describe the pathophysiology that may lead up to the final diagnoses. According to Jin & Mu (2015), Paget in the 19 th century proposed that disseminated cancer cells can form metastases as they reach a microenvironment that is congenial enough for their survival and proliferation. Bone is a major target site for estrogen receptor (ER+) breast cancer metastasis and bone is also rich in estrogen, which, in normal physiology, plays a critical role in the maintenance of bone homeostasis and remodeling. ER+ tumor cells lodging in the bone marrow may have a particular advantage in hijacking the available estrogen for proliferating signal. What pharmacology treatment would you recommend and why? The most common treatments for metastatic breast cancer in any location are systemic medications including chemotherapy, hormonal therapy, targeted

NSG 5003 Week 2 Discussion2 Betty Burns therapies, and bone-strengthening medication. I would start with a hormonal drug such as Tamoxifen. This drug blocks estrogen receptors on breast cancer cells. It stops estrogen from connecting to the cancer cells and telling them to grow and divide (American Cancer Society, 2017). While tamoxifen acts like an anti- estrogen in breast cells, it acts like an estrogen in other tissues, like the uterus and the bones. For women with hormone-positive breast cancer that has spread to other parts of the body, tamoxifen can often help slow or stop the growth of the cancer, and might even shrink some tumors (American Cancer Society, 2017).Betty may also have to get a different regimen of chemotherapy after consulting with an oncologist and may need additional surgical intervention.

American Cancer Society (2017). Hormone Therapy for Breast Cancer. Retrieved from https://www.cancer.org/cancer/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html i-Human Patients Inc. (2018). Betty Burns Part 2 V3 PC PAC(Basic DDx). Retrieved from

https://ih2.i-human.com/attempts/341130/play

Jin, X. & Mu, P. (2015). Targeting breast cancer metastasis. Breast cancer : basic and clinical

research, 9(Suppl 1), 23-34. doi:10.4137/BCBCR.S25460