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Health Assessment > Breast Lymph > Flashcards

Breast Lymph Flashcards

1
Q

Most common place for breast cancer

A

Upper outer quadrant

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2
Q

Axillary nodes—4 groups:

A

a) Central axillary
b) Pectoral (anterior)
c) Subscapular (posterior)
d) Lateral

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3
Q

DC: adolescents

A

onset breast development—mean age 8-9 (African American); 10 (Caucasian)

Now—earlier onset of breast development; early breast development linked to greater BMI and reflects rise in obesity in U.S.

Beginning of breast development precedes menarche by 2 years

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4
Q

DC: pregnant women

A

After 4 months—colostrum may be expressed—until 1st few days after delivery.

Colostrum rich with antibodies

During pregnancy, nipples, areolae larger, darker

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5
Q

DC: Aging adult

A

after menopause—ovarian secretion of estrogen and progesterone decreased.

Breast glandular tissue atrophies, replaced by fibrous connective tissue.

Decreased breast size and elasticity, drooping—accentuated by kyphosis in some older women.

Breast lumps may also be more palpable.

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6
Q

DC: Males

A

during adolescence—temporary enlargement—gynecomastia

Gynecomastia may also occur in aging males as a result of testosterone deficiency.

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7
Q

Breast cancer

A

Tumor suppressor genes—BRCA1 , BRCA2—mutation increases risk for developing breast and ovarian cancers.

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8
Q

Women least likely to have mammogram

A

Less than a high school education
No health insurance
Recent immigrant

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9
Q

SD: Pain

A

assess PQRST; cyclical pain common

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10
Q

SD: Lump

A

how long? Relationship of lump to menstrual cycle

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11
Q

SD: Discharge

A

color, consistency, odor

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12
Q

SD: Rash

A

Where did it start? If involving nipple—think about Paget’s disease

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13
Q

SD: Swelling

A

local or generalized? May be related to menstrual cycle, pregnancy, breastfeeding

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14
Q

SD: trauma

A

can sustain a hematoma from blunt trauma

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15
Q

SD: History of breast disease

A

increased risk of breast cancer with past history breast cancer.

Some have lumpy breasts (benign), which may make breast exam difficult.

Need to know relatives and their age at diagnosis of breast cancer.

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16
Q

SD: Surgery/Radiation:

A

Has the client had a breast biopsy, breast surgery (partial mastectomy; mastectomy)?

17
Q

SD: Medications

A

oral contraceptive use; combined hormonal therapy after menopause—increases risk for breast cancer.

18
Q

SD: Axilla

A

Ask if pt. has experienced tenderness, swelling, lump

19
Q

Screening exams

A

ask about BSE, CSE, mammograms

20
Q

OD: Inspection

A

Inspect for redness, heat, vascular pattern (normal in pregnancy).

Edema—exaggerates hair follicles—“orange peel” look—peau d’orange

Assess axilla for edema, discoloration.

Nipples—usually protrude; assess for discharge.

Have client lift arms over her head—assess for retraction; note lag in movement in one breast; note dimple or puckering.

21
Q

OD: Palpation

A

Axilla—rest arm on your arm—palpate in 4 directions.

What are the 4 directions?

Breasts—palpate with client in supine position (tuck pad under side to be palpated and raise arm over head (flattens tissue and displaces medially).

Palpate nipple/assess for discharge; if discharge, note quadrant producing discharge.

22
Q

Breast lump documentation/assessment

A
  1. Location—using a clock face—note distance in cm from nipple or diagram breast and mark the location of the lump.
  2. Size
  3. Shape
  4. Consistency (soft, firm, hard)
  5. Movable
  6. Distinctness—single or multiple
  7. Nipple displaced or retracted
  8. Skin over lump—erythema, dimpled, retracted
  9. Tenderness
  10. Lymphadenopathy
23
Q

More advanced cancer

A 
Breast mass
Retraction
Edema
Axillary mass
Scaly nipple
Tender breast
24
Q

Breast may normally be tender and edematous before

A

meals

25
Q

Post-mastectomy

A

lymphedema of upper arms common sequela—due to interruption of lymphatic drainage and removal of nodes

26
Q

Breast Self Exam (BSE), positions, best time

A
  1. Supine—palpate using vertical strip pattern.
  2. Sitting up—palpate under arm, with arm raised.
  3. Hand on hips with shoulder hunched—inspect in mirror, noting surface changes.
27
Q

Male breast cancer

A
  1. usually presents with retroareolar lump; nipple discharge rare but strongly associated with cancer.
28
Q

Adolescent gynecomastia

A

benign—seen in ½ adolescent boys (age 13, 14)—temporary

29
Q

OD: DC: Aging adult

A

Breasts pendulous, flattened, sagging; on palpation, more granular.

Terminal ducts around nipples feel more prominent and stringy; more prominent inframammary ridge.

Teach to use talcum powder for BSE—helps fingers glide over skin.

Health Assessment (12 decks)

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