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HA: Exam 2 > Breast and Lymphatic Systems > Flashcards

Breast and Lymphatic Systems Flashcards

1
Q

Breast structures and function

A

Function: Paired mammary glands that produce and store breastmilk

Structures:

  1. Lobes/lobules (glandular tissue): produce breastmilk
  2. Lactiferous ducts: carry breastmilk to nipple
  3. Montgomery glands: secrete oil and aroma during breastfeeding (on areola)
  4. Nipple & areola
  5. Tail of Spence: breast tissue that extends into axilla
  6. Cooper’s ligament: provides structure for breast tissue
  7. Pectoralis major and serrates anterior muscles
  8. Lymph nodes
  9. Supernumerary nipples: extra nipples that may appear along the embryonic “milk line”
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2
Q

Lymphatic system

A

Drains cellular waste/debris and recirculates interstitial fluid

Primary locations: axilla, sternum, and breast

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3
Q

CC/COLDSPA

A

Breast or axillary lumps/swelling/mass/rash/scaling?

Change in size/shape?

Pain/tenderness?

Nipple tenderness/pain/discharge (especially blood)?

Tender breasts with menses?

Breast redness/warmth/dimpling (may be d/t malignant tumor)

Medications: discharge s/t prescribed meds. that treat endocrine disorders (HTN, antidepressants, antipsychotic, ERT)

Males: can also have breast/lympathic concerns/symptoms

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4
Q

PMHX

A

Age of menarche/menopause?

Pregnancies/children and breastfeeding or nulliparity

Breast CA/biopsy/surgeries/implants/augmentation or reduction?

Mastitis or breast access?

Women who have fibrocystic breasts will often have lumps that increase in size 1-2 weeks prior to menses (and diminish during/after menses)

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5
Q

FHX

A

First and second-degree relatives diagnosed with breast CA

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6
Q

Lifestyle and health practice & BSE

A

Recent changes during BSE? (however, mammogram is “gold standard”)

Contraception use/hormonal therapy: can cause irregular menstrual cycles and breast tenderness

Nutrition and diet (and caffeine intake)

Alcohol use

Exercise

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7
Q

ROS

A

Head-to-toe

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8
Q

Breast augmentation/implants and breast reduction

A

Location of augmentation/implants:

  1. Subglandural placement: on top of chest wall
  2. Submuscular placement: underneath chest wall

Breast reduction: wedge of extra skin and breast tissue is excised and brought together; may result in nipple scar, but permits ability to breastfeed

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9
Q

Mastitis

A

An inflammatory infection of the breast tissue; symptoms can progress from localized (pain, swelling) to systemic (malaise, fever, flu)

Occurs more often in lactating women, but also non-breastfeeding women

S/S: Breast pain, swelling, redness, fever, enlargement, changed nipple sensation, discharge, itching, tenderness, breast lump

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10
Q

Breast abscess

A

A painful build-up of pus in the glands caused by an infection; breast become hard, tender

A complication of mastitis

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11
Q

Mammogram screenings for breast CA

A

Screening of choice; variating factors:

  1. Age
  2. Dense breast
  3. Individuals with higher than average risk factors (alcohol intake, FHX)

Males: Gynecomastia (increased breast tissue); breast CA is rare and usually not diagnosed until late stages

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12
Q

Non-modifiable risk factors

A

Gender (female)

Increasing age (older clients may notice a decrease in size/firmness of breast d/t decreased estrogen)

Genetics

Race/ethnicity

PMHX

FHX (5-10% breast CA are hereditary; related to BRCA1/BRCA2 genes)

Increasing density/consistency

Early menses (prior to 12 yrs. of age d/t prolonged exposure to progesterone)

Chest radiation exposure

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13
Q

Lifestyle/modifiable risk factors

A

Breastfeeding (decreases risk for breast CA; increased risk >30 yrs. of age)

Oral contraceptives (estrogen)

Menopausal HT

Alcohol consumption

Excess weight/obesity

Limited physical exercise

Diet

BSE and regular mammogram screening

Night work

Smoking/second-hand

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14
Q

Physical assessment preparation

A

Prep the pt: Provide privacy to undress and front-snap gown

Equipment: Cm. ruler, small pillow, gloves, specimen slide, BSE pt handout, chaperone

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15
Q

Physical assessment

A

Techniques: INSPECTION & PALPATION (vertical/wedge/circular; depth: light/medium/deep)

Anatomic landmarks: breast quadrants, tail of Spence

Positioning: Sitting, hands on hips, hands over head, leaning forward, clenching hands, supine with pillow under shoulder

General routine screening:

  1. Inspect breast and nipple size/symmetry/color/texture, superficial venous pattern, dimpling
  2. Palpate for texture/elasticity, tenderness/temperature
  3. Pt demonstrates BSE

Focused speciality assessment:

  1. Inspect and palpate axilla and lymph nodes
  2. Palpate breast for masses, nipples for discharge, mastetcomy or lumpectomy site for redness/lesions/lumps/swelling/tenderness
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16
Q

Inspection

A

Compare breast size/shape/color/texture, bilaterally

Nipple and areola position/direction/discharge, bilaterally (pregnant women have enlarged nodule-like breast, darkened nipples)

Axilla color/lesion/rashes

Superficial venous patterns

Dimpling

17
Q

Palpation

A

Use flat pads of three fingers to palpate

Breast: Consistency/masses/tenderness/nodules, skin texture/elasticity/temp.

Assess lumps for: Location, size, shape, consistency, mobility, tenderness, distinctness

Nipple: Elasticity/masses/tenderness, discharge (milk discharge with breastfeeding compared to brown discharge with mastitis)

Lymph nodes: Axillary, epitrochlear, clavicular; Normal: No palpable nodes OR 1-2 small, discreet, non-tender, movable nodes in central area (enlarged, hard, fixed axillary nodes indicate malignancy)

18
Q

Palpation of male breasts

A

Inspect and palpate breasts, areolas, nipples, axilla; Normal: No swelling, nodules, ulcerations

Gynecomastia; younger males d/t pubertal hormones

19
Q

Clinical warning signs of breast CA

A

S/S:

  1. Redness
  2. Swelling or enlargement
  3. Pain or itchiness
  4. Thickened, ridged, or dimpled skin
  5. Swelling of lymph nodes in axilla or below collarbone
  6. Inverted or retracted nipple

Ex.: Clinical manifestations of breast CA: Irregular, firm lumps; orange peel-like appearance; dimpling and nipple retraction

20
Q

Breast mass characteristics

A

Size/shape/anatomical position

Mobility

Consistency

Temp.

Tenderness

Delimitation

Redness

21
Q

Older adult considerations

A

Breast are pendulous (d/t increase in fatty tissue; assess by leaning forward), less firm, granular, smaller in size

Smaller, flatter nipples less erect on stimulation

Possible lumpectomy or mastectomy (and removal of lymph nodes with CA)

22
Q

Additional abnormalities

A
  1. Fibroadenomas: non-cancerous breast lumps that are round, firm, well-defined, singular, mobile (seldom tender); occur most often in women 15-35 yrs. of age
  2. Fibrocystic lesions: benign breast lesions that may be multiple in number, firm, rubbery, elliptical or round, mobile; often bilateral and tender just before menses
  3. Peau d’ orange: pigskin-like appearance found in metastatic breast disease; caused by breast edema from blocked lymph node (indicative of advanced CA)
  4. Paget’s disease: areas over the areola that are red, scaly, crust-like, ulcerous
  5. Acanthosis nigricans: can be associated with an internal malignancy (polycystic ovarian syndrome, hirsutism, obesity, irregular periods, infertility, ovarian cysts, early-onset T2DM)

Other: Benign breast disease, retracted nipple/breast tissue, dimpling, mastitis

23
Q

BSE

A

Should be conducted 5-7 days following menses with light/medium/deep palpation pressures

General BSE:

  1. Examine in shower
  2. Examine in mirror with arms down, up, on hips
  3. Stand and press fingers on breast in an up/down or circular approach
  4. Lie supine and palpate
  5. Palpate nipple for discharge

HA: Exam 2 (6 decks)

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