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T.R. notice multiple duct discharge, and the chances of malignancy is low. Intermittent and bilateral clear nipple discharge from both the breasts is relevant to a benign condition, ectasia (Jiang et al., 2020). According to age-specific recommendations, T.R. is near menopause in which mammary glands are widened and dilated to result in duct blockage. These blockages result in the leaking or discharge of nipples (Cetin and Sıkar, 2020). The diagnostic testing is blood tests, prolactin levels, TSH (Thyroid-Stimulating Harmone) levels, cytology (if breast mass is expected during physical examinations). Imaging tests are ultrasonography for the presence of cystic and solid masses. When the lesions are masses are not present, and the physical and examination reveals the risk factor of cancer, mammography should be followed by biopsy-guided imaging to detect malignant cells (Cetin and Sıkar, 2020).

The presumptive diagnosis is mammary duct ectasia, a non-cancerous condition of nipple discharge in early menopausal women. The ICD code for the detected disease is N60.49. The management plan includes pharmacological and non-pharmacological approaches to treat the disease (Jiang et al., 2020). The first-line treatment for T.R. is a 10-15 days complete course of antibiotics along with pain-relieving medications (acetaminophen, ibuprofen). Although the need for surgical intervention is rare, mammary duct incisions are recommended if the diseased status is worsened (Cetin and Sıkar, 2020). Alternative treatment strategies are the application of warm compress, using breast pads, well-fitted clothing, nutritious diet, encourage healthy social habits (quit smoking, substance use), and relaxation therapies to reduce stress and anxiety (Jiang et al., 2020).

The differential diagnosis for bilateral and intermittent nipple discharge could be fibrocystic breasts (ICD code: N60.19), galactorrhea (ICD code: O92.6), Paget’s disease of the breast (ICD code: C50.019), and periductal mastitis (N61.0). Primarily, T.R. would be experiencing duct ectasia based on the physiological evaluation. The patient is reporting frequent headaches and visual disorders that could be associated with increased stress (Song et al., 2018). Thus, psychological assessment is recommended to provide significant health potential to the patient. Also, genetic evaluation is crucial to determine the risk of intraductal carcinoma (result in multiple duct discharges) and Paget’s disease (a rare form of breast carcinoma). Functional impairment, such as depression, schizophrenia, and PTSD (Post-Traumatic Stress Disorder), causes hormonal alterations to increase prolactin and testosterone hormones in women, resulting in intermittent and bilateral nipple discharge (Belonenko et al., 2016).

The different family development stages of health assessment include self-examination, patient education, follow-ups, and counseling (Belonenko et al., 2016). For example, self-examination is finding lumps, lesions, masses, or breast abscess to assist physicians with their care plan. Nursing staff should educate patients for self-evaluation skills (nipple inversion, changes of breast skin, moles, rashes), emotional transitions, or anxiety-oriented disorders (Belonenko et al., 2016). Psychological findings are necessary because stress is the barrier to achieving the therapeutic outcome of a disease. Also, physical and mental counseling determine the overall health status of the patient. The family life cycle stages acknowledge the treatment challenges to evaluate decision-making approaches. Family structure and function is the major domain of rehabilitation or treating any disease (Song et al., 2018). The family infrastructure should include open communication, prioritization of the family members, and servitude strategies towards one another. Most importantly, these values are integrated into health care in the early reformation of acute or chronic diseases.

References

Belonenko, G.A., Grintsov, A.G., Osipov, A.G., Pilyugin, G.G., Lutsenko, Y.G.,

Aksenova, E.G., Aksenov, A.A. (2016). [Diagnosis and treatment of inflammatory

diseases of the mammary ducts]. Khirurgiia (Mosk). (11):54-58. [PubMed]

Cetin, K., Sıkar, H.E. (2020). Evaluation and management of pathological

nipple discharges without using intraductal imaging methods. Ir J Med Sci.

189(2):451-460. [PubMed]

Jiang, L., Li, X., Sun, B., Ma, T., Kong, X., Yang Q. (2020). Clinicopathological

features of granulomatous lobular mastitis and mammary duct ectasia. Oncol Lett.

19(1):840-848. [PMC free article] [PubMed]

Song, L., Li, L., Liu, B., Yu, D., Sun, F., Guo, M., Ruan, Z., Zhang, F. (2018).

Diagnostic evaluations of ultrasound and magnetic resonance imaging in

mammary duct ectasia and breast cancer. Oncol Lett. 15(2):1698-1706.

[PMC free article] [PubMed]