breast and lymphatic assessment Flashcards
when collecting subjective data if someone reports a lump what should you do (Exam)
If a woman mentions a breast lump that she has discovered herself, examine the unaffected breast first to learn a baseline of normal consistency for this woman
what should be done when collecting subjective data about breasts and lymphatics (Exam)
- Breast pain, lumps, discharge, rash, swelling, or trauma
- History of breast disease
- Surgeries or radiation
- Medications
- Family history of breast cancer or related conditions
- Hormonal influences: oral contraceptives, hormone replacement therapy
- Breast self-exam (BSE) practices and last mammogram
- Axillary concerns: tenderness, lumps, swelling, rash
breast surface anatomy
- Breasts lie anterior to the pectoralis major and serratus anterior muscles.
- Tail of Spence: Superior lateral corner projects up and laterally into the axilla.
- Areola Surrounds the nipple
- Montgomery glands: secrete protective lipids during lactation
breast internal anatomy
- Internal anatomy composed of glandular,
fibrous, and adipose tissue. - Glandular tissue has 15-20 lobes radiating from the nipple.
- Lobes embedded in adipose tissue
- Lymphatic drainage includes central, lateral,
pectoral, and subscapular nodes. - The breast may be divided into four quadrants by imaginary horizontal and vertical lines intersecting at the nipple
lymphatics with breasts
the breast has extensive lymphatic drainage
- from the central axillary nodes, drainage flows up to the infraclavicular and supraclavicular nodes
the four groups of axillary lymphatic nodes present with the breast (Exam)
central axillary nodes
pectoral (anterior)
subscapular (posterior)
lateral
developmental competence of the breast and lymphatics in fetal development
- During embryonic life, ventral epidermal ridges, or “milk lines,” are present and curve down from axilla to groin bilaterally
- Develops along ridge over thorax, and rest of the ridge usually atrophies
developmental competence of breast and lymphatics in adolescence
- At puberty, estrogen stimulates breast changes.
- Breast development usually begins between 8-10 years of age (Exam)
- Temporary asymmetry: Occasionally, one breast may grow faster than the other
- Obesity epidemic -> prime driver in early breast budding & early menarche
developmental competence in breast and lymphatics in aging women
After menopause, ovarian secretion of estrogen and progesterone decreases, causing breast glandular tissue to atrophy
* Decreased breast size makes inner structures more prominent
* A breast lump may have been present for years but is suddenly palpable
* Around the nipple, the lactiferous ducts are more palpable and feel firm and stringy because of fibrosis and calcification
* Axillary hair decreases
developmental competence in breast and lymphatics in men
Rudimentary structure consisting of a thin disk
of undeveloped tissue underlying the nipple
gynecomastia (exam)
during adolescence, it is common for breast tissue to enlarge temporarily
* Condition is usually unilateral and temporary
* Reassurance is necessary for adolescent male whose attention is riveted on their body image
* May reappear in aging males and may be due to testosterone deficiency
breast cancer is
the 2nd major cause of death from cancer in women
early detection and improved treatment have increased survival rates
- 5-year survival rate -> 99% today, 85% if spread regionally in the body
risk profile for breast cancer (exam)
Review factors associated with “relative risk” (RR)
* RR above 1 indicates a higher likelihood of occurrence among exposed than unexposed persons
what percentage of all breast cancer is found in men
- Less than 1% of all breast cancers are found in Men
objective data collection - inspection
Breast symmetry, size, shape, skin changes
* Should be smooth and even in color
* Note any nipple retraction, bulging, redness, dimpling, or lesions
* Should be no drainage unless lactating
* Lymphatic areas: axillary and supraclavicular regions for swelling or discoloration.
objective data collection - palpation (exam)
examine breast tissue using the vertical strip, circular, or spoke-wheel technique.
* Axillary lymph nodes: central, lateral, pectoral, and subscapular.
* Lumps: location, size, shape, consistency, mobility, tenderness.
steps for systematic examination of breast, axilla, and lymph (exam)
- Position the patient upright for inspection, then supine for palpation.
- Inspect breasts with arms at the sides, raised overhead, and hands on hips.
- Palpate the breast tissue methodically to detect abnormalities.
- Examine the axillary region for lymph node enlargement or tenderness.
- Document any findings using precise anatomical landmarks.
- Provide patient education on self-breast examination and risk awareness.
expected findings and variations of skin color and conditions
- Expected Findings
- Smooth, similar in color to surrounding skin
- Expected Variations
- Visible veins bilaterally
- Striae visible bilaterally
- Inflammation underneath
unexpected findings of skin color and condition
- Thick, rough skin
- Unilateral vein dilation
- Dimpling
- Edema
- Inflammation
- Unilateral rash
- Peau d’orange
what is Peau d’orange
a skin appearance on the breast that resembles the texture of an orange peel, often characterized by dimpling and pitting, and is most commonly associated with inflammatory breast cancer
expected findings and variations in shape and size of the breasts
Expected Findings
* Similar in size
* Smooth contour
Expected Variations
* Scars
* Gynecomastia in male
* Atrophy
unexpected findings in breast shape and size
Significant size, contour differences
Dimpling, retraction of skin
Bulging
expected and unexpected findings of the areolas and nipples
- Skin Condition
- Expected Findings
- Round, oval
- Visible Montgomery glands
- Smooth without open areas, crusting, rash, drainage
- Unexpected Findings
- Dry scaling
- Discharge
- Expected Findings
expected and unexpected findings of symmetry, alignments, and orientation of the areolas and nipples
- Expected Findings
- Symmetrical with alignment
- Nipples same direction
- Expected Variations
- Supernumerary nipple
- Unexpected Findings
- Nipple inversion or direction change
expected and unexpected findings of the axillae
- Expected Findings
- Smooth, intact
- No discoloration, edema, rash
- Expected Variation
- Lymphedema after mastectomy
- Unexpected Findings
- Edema
- Rash
- Pigmentation
expected and unexpected findings of the lymph nodes
- Expected Findings
- Not visible
- No discomfort
- Unexpected Findings
- Visible
what to document about the findings
- Evaluate lump characteristics
- Location – use clock face for reference (12 O’clock)
* Include distance from nipple - Size - in cm
- Shape - oval, round, lobulated, indistinct
- Consistency – Hard, soft, firm
- Mobility – freely moves or fixed
- Distinctness – solitary or multiple
- Nipple – displaced or retracted
- Note skin over the lump – erythematous, dimpled, retracted
- Tenderness – tender to palpation
- Lymphadenopathy – are regional lymph nodes palpable
- Location – use clock face for reference (12 O’clock)
health promotion and patient education for breast and lymphatics
- Teach breast self-exam (BSE) for awareness,
not as a sole screening method. - Encourage regular mammograms based on
age and risk factors. - Discuss lifestyle modifications: weight
management, physical activity, alcohol intake.
the way to easily teach breast self-examination (BSE)
- The simpler the plan, the more likely the person is to comply
- Describe correct technique and rationale and expected findings to note as woman inspects her own breasts
- Then palpation should be performed while lying supine
Encourage woman to palpate her own breasts while you monitor her technique - Use of model for return demonstration as well as pamphlets may be helpful
what may BSE’s detect between mammograms
breast self exams may detect lumps between mammograms
