Breast and Male GU Assessment (complete) Flashcards
Montgomery’s glands
Areola surrounds nipples contain small elevated
sebaceous gland.
secrete protective lipid material
during lactation
Breast is composed of: (3)
Glandular tissue
Fibrous tissue including suspensory ligaments
Adipose tissue
Glandular tissue contains (lobes #)
15 to 20 lobes radiating
from nipple, and these are composed of lobules
most breast tumors found…where? First like spot and second likely spot
Upper outer quadrant-axillary tail of Spence
#2 Inner lower quadrant of breast
Upper outer quadrant called
Tail of spence
What simulates breast changes?
Estrogen
Developmental considerations (adolescents)
Breast development begins around…
period starts when
8-9 years old for african american
10 years old white girls
Period starts 2 years after breast development
Developmental considerations (pregnancy) Breast changes
Breast changes start during the second month of pregnancy
-enlargement, more nodular, nipples are larger, darker and more erectile.
Developmental considerations (pregnancy) - colostrum/lactation
Colostrum may be expressed after 4th month.
-thick yellow fluid-precursor for milk
- contains same amount of protein and lactose but no fat
-Lactation: begins 1-3 days post partum
Developmental Considerations: Older Woman
Post menopause
- estrogen and progesterone secretion decreases causing breasts to decrease in size
-inner structures more prominent/ lumps finally palpable
- any changes should = follow up in care
-Breasts look pendulous, flat and saggy
-Nipples could be retracted but can be pulled back out
-When palpating- breasts feel more granular
Breast cancer
Lower risk: Asian, Hispanic, and American Indian women
Focused questions: Subjective
Pain, lump/mass, swelling, discharge, rash, trauma, Hx breast disease (family or self), surgery (implants), self-care behavior, Perform self-breast exam?, Last mammo?,
Axilla: swelling, tenderness, lump, rash
Focused Questions: breast (Pain)
Pain:
Where (point to it)
burning or pulling sensation?
Is pain cyclical/ related to menses?
Brought on by strenuous activity, especially involving one arm, underwire, sex etc
Focused Questions: breast (Lump)
Lump or thickening? Where? when did you notice it? any changes?
Cyclical?
Skin changes- warmth, redness, swelling, DIMPLING?
Discharge-
From nipple? when? color/ odor/ consistency? (get specimen container if necessary)
Focused Questions: breast (Rash/swelling)
Rash-
When did you notice? Where did it start? nipple, areola, surrounding skin
Swelling
one spot or all over?
Cyclical/pregnancy/breastfeeding related?
Changes in bra size
Focused Questions: breast (Trauma/Hx breast disease)
Any trauma or injury to breasts? Did it result in swelling/lump/break in skin?
Hx of breast disease:
Self or family?
Type and diagnosis?
When?
How often to get a mammogram/ clinical breast exam
age 20-39 years- clinical breast exam every 3 years
after 40: annual
Inspection (patient supine)
-Symmetry and size of breasts
-SLIGHT asymmetry (often L larger)
Skin- smooth and skin homogenous
shouldn’t be any edema or localized areas of redness, bulging, dimpling, lesions, or focal vascular pattern.
Inspection (Nipple)
Should be symmetrical, on same plane.
some nipples may be flat or inverted (can be easily pulled out)
Note any dry scaling, fissure or ulceration, bleeding, discharge
supernumerary
3rd nip
along the “milk line” on abdomen
Assessment (patient seated)
inspect axillae.
-Lift womans arm and support it so that muscles are loose and relaxed.
-Note any rashes or infection
-Reach fingers high into axilla, move them FIRMLY down in 4 directions
Which pattern is most common to detect breast mass, currently?
- Vertical strip pattern
How to do the vertical strip pattern
-Use pads of first 3 fingers
-Arm over head to flatten breast
-start high in axila-palpate down to lateral breast
overlap vertical lines ending
at sternal edge
Normal breast should be..(3)
smooth, firm, elastic
Premenstrual breasts
engorgement, slightly enlarged
If patient mentions a lump…
examine the unaffected breast first for baseline
Signs and symptoms of breast cancer (8)
Irregular shape
firm to stony hard
poorly defined (no clear margins)
single in number
fixed, non mobile
usually non tender
positive skin retraction
constant growth
S/S of advanced BC (BREAST)
B.R.E.A.S.T
Breast mass
Retration
Edema
Axillary Mass
Scaly nipple
Tender breast
Best time to do a SBE
right after period
Gynecomastia
Male growth of breast tissue-
during puberty
-normal and temporary
Inspect Male GU: scrotum/testes
No lesions
Scrotum
-asymmetry is normal
-Contents should slide easily
-Testes: oval, firm, rubbery, smooth, equal, freely movable.
Scrotum: structure and funciton
Loose protective sac; continuation of abdominal wall
after puberty- scrote skin deeply pigmented and has large sebaceous follicles
- scrotal wall consists of thin skin lying in folds, or rugae, and underlying cremaster of muscle
Scrotal septum
inside scrotum and separates sac into halves. Each contains a testi.
Spermatic cord
suspend the testes.
L teste is longer because L spermatic cord is longer
Developmental Considerations: Infants
Testes develop in abdominal cavity
only get slightly larger until puberty happens
Developmental Considerations: Adolescents
Puberty begins between ages of 9½ and 13½
First sign is enlargement of testes
Next, pubic hair appears, then penis size increases
Complete change in development from preadolescent to adult takes around 3 years, although normal range is 2 to 5 years
Developmental Considerations: Adult and aging men
Testosterone production declines after age 55 to 60 years
Pubic hair decreases and penis size decreases
Scrotal contents hang lower, rugae decrease, and scrotum becomes pendulous
Testes decrease in size and are less firm to palpation
Assessment: Inspect and palpate scrotum
-Inspect scrotum as male holds penis out of the way; alternatively, you hold penis out of the way with back of your hand
-Scrotal size varies with ambient room temperature; asymmetry is normal, with left scrotal half usually lower than right
-Spread rugae out between your fingers, lift sac to inspect posterior surface
-Normally, no scrotal lesions are present, except commonly found sebaceous cysts; these are yellowish, 1-cm nodules that are firm, nontender, and often multiple
Assessment: Inspect and palpate scrotum
Palpate gently each scrotal half between your thumb and first two fingers
Palpate each spermatic cord between your thumb and forefinger, along its length from epididymis up to external inguinal ring
Testicular cancer most common between ages..?
20-35
T;S;E
T: timing, once a month
S: shower, warm water relaxes scrotal sac
E: examine, check for and report changes immediately
