Women's health nurse practitioners are responsible for provision of the primary assessment of breast changes - referring for screening as appropriate and referral to the breast specialist.
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Women's health nurse practitioners are responsible for establishment of a process for ensuring follow up of women who fail to attend the required medical consultation.
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Women's health nurse practitioners will provide:
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- consistency in assessment and management of women with breast changes
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- optimal care in the management of women with breast changes
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- continuity of direct care or secondary referral as necessary
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Eligible women are women who:
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- report breast changes or abnormalities
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- present as asymptomatic, but on examination the women's health nurse practitioner detects suspicious findings
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History
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The women's health nurse practitioner will document:
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History of presenting symptom
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Client history
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- changes in menstrual cycle and last normal menstrual period (LNMP)
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- current medications and recent changes in medication with particular attention to hormonal medications
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- breastfeeding or recently ceased breastfeeding
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- history of breast problems including previous ultrasound/mammogram/biopsy/surgery and results
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- family history of breast cancer, age of diagnosis and relationship
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- family history of ovarian cancer, uterine cancer or sarcoma, age of diagnosis and relationship
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- most recent imaging, screening, diagnostic, date and results
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- parity and age at first full-term pregnancy
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- age at menopause and/or menarche
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- social factors - alcohol intake, smoking, caffeine use
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Inspection
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The women's health nurse practitioner will document:
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- change of contour, swelling, visible lumps
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- nipple retraction, asymmetry of breasts or nipples, redness, inflammation
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- skin puckering, dimpling, itch
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Palpation
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The women's health nurse practitioner will assess and document:
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- Size and position of abnormal area
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- Outline (smooth/irregular)
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- Axillary glands palpable/non palpable
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If a nipple discharge is noted, the women's health nurse practitioner will record the discharge, describing:
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- whether bilateral / unilateral
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- bloodstained / not bloodstained
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- whether the discharge is spontaneous or with expression
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Any abnormal sign/symptom should be accompanied by diagrammatic representation.
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Management of lumps
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Investigations prior to referral to breast surgeon
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Under 35 years or pregnant:
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- mammogram only if malignancy suspected and a strong family history present
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Over 35 years:
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- ultrasound (if lump is consistent with cyst, if there is a history of breast cysts and if the woman has had a normal mammogram in the last 12 months, as per National Guidelines)
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- imaging should be timed for the week following menstrual period, if applicable, for comfort
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- Some discussion with referring breast surgeons regarding individual protocols is advisable
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Management of breast symptoms
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Women presenting with abnormal examination including breast thickening, nodularity, pain or nipple discharge should be referred with appropriate investigation.
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Further referral
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Where appropriate and as indicated by history, women may also be referred to:
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- family cancer genetic services
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Women with no abnormal signs or symptoms should be advised to:
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- Report breast changes promptly to the medical practitioner
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- Attend for screening mammograms according to the policy of BreastScreen Australia
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Links to consumer information
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- the Women's patient information fact sheets: Benign breast conditions
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- Cancer Council of Victoria: Breast health
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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