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Discussion: Week 7
The onset of breast development is one of the main signs of a girl in Tanner stage 2. The girl’s nipples and breast form a small mound. The other characteristics of Tanner stage 2 include the onset of pubic hair development and increase in height growth. Menses normally begins at Tanner stage 4. However, Menarche occurs in a small percentage of girls in Tanner stage 3 (Littleton-Gibbs & Engebretson, 2012, p. 109). Therefore, the mother should not worry about her daughter starting menses until she starts to show some signs of Tanner stage 3.
According to Potter, Perry, Hall, and Stockert (2016), the three common methods used for ensuring the palpation of the entire breast are the strip, concentric circle and wedge method. The strip method involves palpating the breast from the top to the bottom in vertical strips. On the other hand, the concentric circle method involves palpating the breast using circular movements. The wedge method involves palpating the breast outwards from the center in wedge sections (p. 586).
According to Weber and Kelley (2013), breast retraction and dimpling often signify the presence of a malignant tumor. A normal breast should be symmetrical. The typical tumor will have fibrous strands attached to the breast tissue and muscles. The contraction of the fibrous strands pulls the breast tissue and skin causing the retraction and dimpling (p. 407).
A patient in her first trimester of pregnancy should expect several changes in her breasts. First, the breasts will become large and feel tender. Secondly, the nipple will become big and begin to darken. The patient should avoid the use of potent drugs unless they are necessary. This precaution is necessary to prevent adverse effects on the development of vital organs during the first trimester (Simkin, Whalley, Keppler, Durham, & Bolding, 2016). The patient should take adequate amounts of vitamins, folic acid and iron supplements.
According to Potter et al. (2016), the breasts in postmenopausal women are flaccid, elongated and pendulous. The nipples are flatter in comparison those in a premenopausal woman. These changes result from the decline in the production of estrogen and weakening of ligaments that support the breast tissue (p. 583).
Acute pancreatitis is the most probable cause of the described symptoms. The condition occurs due to the sudden inflammation of the pancreas. The inflammation results due to the retention and premature activation of the digestive enzymes inside the pancreas (Dudek, 2010). These enzymes begin to digest the pancreas leading to the sudden inflammation and onset of severe epigastric pain.
According to Lang (2009), the three types of acute cholecystitis are acute calculous cholecystitis, acute acalculous cholecystitis and emphysematous cholecystitis. Acute calculous cholecystitis occurs in the presence of gallbladder stones. On the other hand, acute acalculous cholecystitis occurs in the absence of gallbladder stones. Emphysematous cholecystitis occurs when gas-forming bacteria infect the gallbladder wall
The method used during liver palpation applies in palpating the gallbladder. The normal gallbladder is hidden by the lower border of the liver and thus not palpable. A palpable gallbladder will feel as a firm and smooth swelling lateral to the rectus abdominis near the ninth cartilage (Rao, 2014). The palpation involves placing the flat of the right hand on the abdomen and advancing upwards lateral to the rectus abdominis.
Cholecystitis causes a blunt and squeezing abdominal pain, which often starts in the right upper quadrant of the abdomen and radiates to the back and shoulder. On the other hand, acute pancreatitis produces a continuous penetrating pain, which radiates to the groin and back (Leeuwen & Bladh, 2016). A nephrolithiasis produces a sharp cutting pain chest pain that radiates to the abdomen and groin.
References
Dudek, S. G. (2010). Nutrition essentials for nursing practice. Philadelphia, PA: Lippincott
Williams & Wilkins.
Lang, F. (2009). Encyclopedia of molecular mechanisms of disease. Berlin: Springer.
Leeuwen , A., & Bladh, M. L. (2016). Textbook of laboratory and diagnostic testing: practical
application at the bedside. Philadelphia, PA: F. A. Davis Company.
Littleton-Gibbs, L. Y., & Engebretson, J. (2012). Maternity nursing care. Clifton Park, NY:
Cengage Learning.
Potter, P. A., Perry, A. G., Hall, A., & Stockert, P. A. (2016). Fundamentals of nursing.
St. Louis, MO: Elsevier Health Science.
Rao, D. (2014). Clinical manual of surgery. Salt Lake: Elsevier Health Sciences.
Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2016). Preconception: Improve
Your Health and Enhance Fertility. New York: Simon and Schuster.
Weber, J., & Kelley, J. (2013). Health assessment in nursing. Philadelphia: Lippincott Williams
& Wilkins.
