breast+ lympathic system Flashcards
Where are the breast located?
- the breasts lie anterior to the pectoralis major and serratus anterior muscles
- located anterior to the pectoralis major and serratus anterior muscles
- the nipple is just below the center of the breast
What surrounds the nipple?
- the areola
- it has smooth muscle fibers that cause nipple erection when stimulated
What do the breasts have an extensive amount of?
-lymphatic drainage
What stimulates breast changes during adolescents?
estrogen hormone
-on occasion, one breast grows faster than the other, which results in a temporary asymmetry (can cause distress in pt)
How to breasts change in non pregnant women?
- they change with the flow of hormones during the monthly menstrual cycle
- during 3-4 days before menstruation, the breasts feel full, tight, heavy and occasionally sore
What is an early sign of pregnancy?
breast changes
-pregnancy stimulates the expansion of the ductal system and supporting fatty tissue, as well as developmental of the true secretory alveoli
What may be expressed after 4 months of pregnancy?
- colostrum
- its a thick yellow fluid and its the precursor to milk
- it is also produced for the first few days after delivery- it is rich with antibodies that protect the newborn against infection
When does milk production (lactation) begin?
begins 1-3 days after post partum
What does colostrum contain?
it contains the same amount of protein as breast milk but practically no fat
What is it called when men have large breasts?
gynecomastia
- it is common during adolescents for breast tissue to temporarily enlarge
- reassurance is necessary
When can gynecomastia reappear?
It can reappear in older men and may be the result of testosterone deficiency.
what is dimpling of the breast?
- its an abnormal finding
- it is shallow dimpling that is a sign of skin retraction
- cancer causes fibrosis, which contract the suspensory ligaments
- dimple may be apparent at rest, with compression or with lifting the arms
what does breast cancer look like?
- solitary unilateral nontender mass
- single focus in one area, although it may be interspersed with other nodules
- solid, hard, sense, and fixed to underlying tissue or skin as cancer becomes invasive
- most common in supper outer quadrant
what is mastitis?
- an inflammatory mass before abscess formation
- area is hot, swollen, tender, and very hot to touch
- occurs during first 4 months of lactation from infection or from stasis from a plugged duct
- treat with rest, antibiotics and frequent nursing to keep breast as empty as possible
what is the scrotum?
- a loose protective sac that is a continuation of the abdominal wall
- best temp for producing sperm is 3 degrees Celsius below abdominal temperature
- the septum seperates the sac into two halves
which testicular sac is lower?
the left is lower than the right because the left spermatic cord is longer
what is the epididymis?
a markedly coiled duct system and the main storage site of sperm
-the lowest part of the epididymis is continuous with muscular duct, the vas deferens
where is the vas deferens continue?
-its continues back and down behind the bladder, where it joins the duct of the seminal vesicle to form the ejaculatory duct. this duct empties into the urethra.
what is the inguinal area?
- or the groin
- is the juncture of the lower abdominal wall and thigh
- this is a potential site for hernia. which is a loop of bowel protruding through a weak spot in the musculature
when does puberty begin?
somewhere between ages 9 and a half and 13 and a half
do men experiance a definite end to fertility?
they dont!
- at 40 years of the production of sperm begins to decrease, although it continues to produce into thier 80’s and 90’s
- older man are capable of sexual function, even chronic illness doesnt put a completely end sexual desire or activity
what are the first signs of puberty in boys?
- enlargement of the testis
- public hair appears
- penis size increases
what are some common reasons for circumcision?
- hygiene
- avoidance of a later need for circumcision
- medical indications
- fathers circumcision status
- religious or cultural values
- it reduces transmission of HIV to an uninfected female by 53-60%
what should be taught to parents with an uncircumcised child?
- clean with soup and water, but the foreskin should not be forcibly retracted
- when the foreskin retracts easily, the area under the foreskin should be cleansed occasionally
what is some subjective data questions?
- frequency, urgency, Nocturia
- are u urinated more than normal?
- Dysuria: any pain or burning when urinating?
- Hesitancy or straining?-any trouble starting a stream?
- Urine color?
- incontinence?
- genital self care-any lumps or swelling?
- sexual activity and contraceptive use?
how should a nurse act when examining men’s genitalia?
-your demeanor should be confident and relaxed, unhurried yet businesslike
If an erection does occur, what should a nurse do?
-DO NOT stop the examination or leave the room, this only focuses more attention on the erection and increases embarrassment. Reassure the male pt that this is only normal physiological response to touch, just as when the pupil constricts in response to bright light
what objective data to collect about the penis?
- inspect and palpate the penis
- the skin normally looks wrinkled, hairless and without lesions
- if you note urethral discharge, collect a smear for microscopic examination and a culture
what objective data to collect about the scrotum?
- the scrotal contents should slide easily
- testes normally feel oval, firm, and rubbery and freely moveable
- scrotal swelling (edema) may be taut and pitting, this occurs with heart failure and renal failure, and local inflammation
what age does testicular cancer most commonly occur in males?
15-49
if detected early by palpation, what is the cure rate?
-almost 100%
what should all men aged 15 and older be aware of?
- they should be aware of how thier testicles normally look and feel and should report changes such as:
- lumps
- a painful testicle
- feelings of heaviness
- dull ache
how often should a testicular exam be done?
-once a month while showering
warm water relaxes scrotal sac
what is Urethritis?
- inflammation of the urethra
- infection of the urethra causes painful burning urination or pruritus
- meatus edges are reddened, everted and swollen with purulent discharge
- urine is cloudy with discharge and mucous shreds
- about 50% of infections are caused by Chlamydia organism
what is testicular torsion?
- sudden twisting of spermatic cord
- occurs in late childhood and early adolescence
- usually occurs on the left side
- blood supply is cut off, which results in ischemia and engorgement necessitating emergent surgery
- pain is excruciating in testicle of sudden onset, may be accompanied by lower abdominal pain
what is the mons pubis?
-a round, firm pad of adipose tissue covering the symphysis pubis, the cartilaginous joint between the two pubic bones
what is the labia majora?
-are two rounded folds of adipose tissue
what is the labia minora?
-inside the labia majora are two smaller, darker folds of skin, called the labia minora
what do the vestibular (Bartholin’s) gland?
- a gland that secretes clear lubricating mucus during intercourse
what are the ovaries?
-serves to develop ova (eggs) and female hormones
what are the fallopian tubes?
-are two paliable tubes, 10 cm, in length, extending from the uterine fundus to the brim of the pelvis and end near the ovaries
what is the uterus?
-is pear shaped thick-walled muscular organ. it is freely movable and tilts forward
what are the walls of the canal made of?
walls are thick in transverse folds, or rugae, which enable the vagina to dilate widely during childbirth
when is irregularity of menstrual cycles common?
-common during adolescents because of occasional failure to ovulate
when a women is about to hit menopause, do hormones decline slowly or rapidly?
in contrast to the slow decline of levels of homrones in aging men, the hormone levels in women decline rapidly
what is menopause and characteristics?
when does menopause occur?
- menopause is the cessation of menses
- usually occurs between 48-51 years
- ovaries stop producing progesterone and estrogen
- sexual desire and need for full sexual expression continues
- older women are capable of sexual function in reasonably good health
what occurs 1-2 years before menopause occurs?
-the menus because irregular and the flow is lighter
what is female genital mutilation?
- is the ritual removal of part or all parts of the external female genitalia
- performed of prepubertal girls
- most common in Africa, asia, and middle east
- is illegal in Canada
- increasing # of immigrant women have undergone this procedure
what are some complications of FGM?
- Urinary tract dysfunction
- painful menstruation
- sexual difficulties
- birth control difficulties
- infertility
- difficulties during pregnancy and childbirth
subjective data for women?
- menstrual history- characteristics of periods
- Obstetrical history- pregnancy? #? Births? abortions?
- menopause: periods stopped or slowed? hot flashes? headaches?
- self care: last pap smear?
- urinary symptoms: problems urinating?
- vaginal discharge- anything unusual?
- sexual activity
- contraceptive use: currently planning or avoiding?
what does normal vaginal discharge look like?
normal discharge is small, clear or cloudy, and always nonirritating
what is the most prevalent STI in Canada?
-HPV
what is responsible for most cases of cervical cancer?
HPV
who is the HPV vaccine recommended for?
- girls between 9-13 (this is before the onset of sex)
- women between 14-26 even if they are sexually active, because they may not have had the infection
- girls aged 14 -26 who had abnormal pap smears, genital warts or cervical cancer
- more recently boys and men aged 9-26 and women up to 45 years of age
what are HPV genital warts?
- painless warty growths, may be unnoticed by women
- pink or flesh-colored, soft, pointed, moist, single or multiple in cauliflower-like patch
- common among sexually active women, especially adolescents
- risk factors include early age at mecarche and multiple sexual partners
what is the anal canal?
- is the outlet of the gastrointestinal tract
- it is surrounded by two concentric layers of muscle called sphincters
what is the internal sphincter?
its a sphincter that is under involuntary control by autonomic nervous system
what is the external sphincter
it is the sphincter that surrounds the internal sphincter, it is under voluntary control
what are the anal columns made of?
they are folds of mucosa
-each anal column contains an artery and a vein
what can occur under conditions of chronic increased pressure in the rectum?
a vein may enlarge forming a hemorrhoid
how long is the rectum?
12 cm long, is the distal portion of the large intestine
where is the prostate gland located?
lies in front of the anterior wall of the rectum
what does the prostate secrete?
-secretes a thin, milky alkaline fluid that helps semen viability
what are the seminal vesicles?
- they project above the prostate
- they secrete a fluid that is rich in fructose, which nourishes sperm, and contains prostaglandins
what are the bulbourethral (cowpers) glands?
- are each the size of a pea and are located inferior to the prostate on either side of the urethra. they secrete a clear, viscid mucus
what does the first stool that is passed by the newborn look like?
- dark green meconium, it occurs 24-48 hours after birth
- infant usually passes stool my reflux, usually after every feeding
- voluntary control of external anal sphincter cannot occur until the nerves supplying the area have become fully myelinated, usually around 1 and a half years to 2 years
subjective data about bowel?
- bowel routine?
- how regular?
- hard or soft?
- constipation?
- changes in bowel habits?
- loose stool or diarrhea?
- vomiting or abdominal pain?
- any rectal bleeding? what color?
- medications? laxatives?
- rectal conditions? itching? burning? hemorrhoids?
- family history- any family history of colon cancer or polyps
- self care behaviours?- usual amount of fiber in diet?
what foods have fiber in them?
cereals, apples
-how much water do u drink daily?
what are some factors that increase colorectal cancer?
- being over age of 50
- having polyps, family history of colon cancer
- having inflammatory bowel disease (ulcerative colitis or crohns disease)
- diet high in red and processed meats
- consuming alcohol
- smoking
- obesity
- being physically inactive
when do symptoms usually appear for colorectal cancer?
-symptoms often appear once the tumor causes bleeding or blocks the bowel
when are colorectal cancer test recommended in Canada
-screening is recommended at least every 2 years for ppl aged 50 and over
what is a fecal occult blood test?
-is the most common type and uses a chemical reaction on a paper card to find traces of blood in the stool from adenomatous polyps or tumors
what is the most common cancer in men in Canada?
prostate cancer
what are some factors that increase the risk of developing prostate cancer?
- over age 65
- family history of prostate cancer
- a diet high in fat
- obesity
- African decent
when do symptoms appear when a person has prostate cancer?
-when the tumor enlarges the prostate and starts to press on the urethra, making the passage of urine difficult or painful or increasing the urinary frequency
what is benign prostate hypertrophy?
- the enlargement of the prostate
- it doesnt increase the risk for prostate cancer, but the symptoms for BPH are very similar to those of prostate cancer
what tests are there for prostate cancer?
- digital rectal exam
- prostate-specific antigen (PSA) (levels will be high)
- blood tests
how to inspect the perianal area
- have pt lay in left lateral position
- spread the buttock wide apart, and observe the perianal region. the anus is normally looks moist and hairless, with course folded skin that is more pigmented that the perianal skin
- the anal opening is tightly closed
- no lesions are present
- instruct pt to bear down and hold breath. (perform the Valsalva manoeuvre. no break in skin integrity or protrusion the anal opening should be present
what are hemorrhoids?
-these painless, flabby papules are varicose veins of the hemorrhoidal plexus
what is an external hemorrhoid?
- originates below the anorectal junction and is covered by anal skin
- when thrombosed, it contains clotted blood and becomes painful, swollen, shiny blue mass that itches and bleeds with defecation
what in an internal hemorrhoid?
- originates above the anorectal junction and is covered by a mucous membrane
what do all hemorrhoids result from?
result from increased portal venous pressure, as occurs with straining at stool, chronic constipation, pregnancy, obesity, chronic liver disease or a low-fibre diet
