breast and regional lymphatic assessment

Question 1

inspection

Answer 1

• General Appearance
  
  • Symmetry, size & shape
  • It is common to have some asymmetry
• Skin
  
  • Observe color, texture, & superficial venous pattern
  • Observe for redness, bulging or dimpling –> what’s going on under the tissue
  • Observe for lesions
  • Observe for excoriation under the breasts (look for redness or irritation)
• Lymphatic Drainage Areas
  
  • Observe axillary & supraclavicular regions
  • Note bulging, discoloration, or edema

Question 2

inspection of nipple

Answer 2

• Size, direction, lesions, dryness, bleeding, discharge
  
  • discharge can be normal if breastfeeding
• Retraction, dimpling
• outward or inward – more imp for breastfeeding

Question 3

inspect axillae

Answer 3

• rash and infxn

Question 4

maneuvers to screen for retraction

Answer 4

• Change position while inspecting for retracting signs
• Both arms over head
• Place hands on hips
• Then push palms together
• Ask women with large pendulous breasts to lean forward

Question 5

guidelines for palpation

Answer 5

• Pt should lie supine with arm over head (same arm as
  breast being palpated)
• Palpate with pads of first three fingers with a rotary motion on the breast
• Choose palpation pattern
  
  • Vertical strip pattern (best way to detect a mass) –> palpate up and down
  • Wedge/Spokes-on-a-wheel pattern –> start @ nipple and go outward and inward
  • Concentric circle pattern
• Be sure to palpate entire breast including tail of Spence
• Vary levels of pressure while palpating in a rotary motion
• Use bimanual technique if palpating large breasts

Question 6

palpation for female breasts

Answer 6

• Texture, elasticity
• Tenderness
• Skin temperature
• Masses
• Surgical site
• Nipple discharge
• Lymph nodes

Question 7

palpation of the female axillae

Answer 7

• Use four directions
  
  • Down chest wall in a line from middle of axilla
  • Along anterior border of axilla
  • Along Posterior border
  • Along inner aspect of upper arm

Question 8

palpation of male breast

Answer 8

• Can be abbreviated but do NOT omit it
• May be combined with anterior thorax examination
  
  • Inspect chest wall for lumps or swelling
  • Palpate nipple for lumps or tissue enlargement
  • Palpate axillary lymph nodes

Question 9

BSE

Answer 9

• General Guidelines
  
  • Best time is right after the menstrual period or monthly if no menses(easy to remember if 1st of every month)
  • Focus on positive aspects of BSE
  • Keep teaching simple
  • Do this in front of a mirror & use varying levels of pressure
    
    • Sitting or standing with arm over head or supine
  • Report any changes to MD

Question 10

characteristics of masses

Answer 10

• Location-use face of the clock
• Size-use cm, width x length x thickness
• Shape-oval, round
• Consistency-soft, firm, hard
• freely movable or fixed
• Distinctness-solitary or multiple
• Nipple-displaced or retracted
• Note skin over lump-erythematous, dimpled or retracted
• Tenderness-tender to palpation
• Lymphadenopathy-are regional lymph nodes palpable – are they swollen? could be malignant or an infxn

Question 11

subjective data

Answer 11

• breast
  
  • pain, lumps, discharge (nipple), rash (on top or bottom), swelling (normal for menstruation and preg), trauma, history of breast disease, surgery or radiation (cancer recurs along surgical incision), patient centered care (BSE and mammogram)
• axilla: tenderness, lumps, swelling, rash

Question 12

objective data

Answer 12

• Client Preparation
  
  • Undress from waist up
  • Wear gown that opens in back
    
    • Lift it up to the shoulders during the exam
• Equipment Needed
  
  • Ruler (cm)
  • Small pillow