CH 18 Breasts, Axillae, and Regional Lymphatics

Question 1

Structure and Function: Glandular Tissue

Answer 1

lobules - clusters of alveoli that produce milk and empty into lactiferous duct

lactiferous sinuses - reservoirs for holding milk

Question 2

Structure and Function: Fibrous Tissue

Answer 2

suspensory ligaments

• support breast tissue
• attach to chest wall

Question 3

Structure and Function: Adipose Tissue

Answer 3

layers of subcutaneous and retromammary fat

- bulk of breast tissue composition

Question 4

Four Quadrants (most common area for breast tumors?)

Answer 4

upper inner/outer
lower inner/outer

upper region is usually where breast tumors are located

Question 5

Lymphatics (4 groups)

Answer 5

central axillary nodes
anterior (pectoral) axillary nodes
subscapular nodes
lateral (brachial) axillary nodes

Question 6

Developmental Competence: Adolescent

Answer 6

puberty (estrogen stimulate breast changes)

more fat deposition (enlargement)

higher BMI linked to earlier onset of breast tissue development

Thelarche - beginning of breast development
Menarche - onset of menstruation

Question 7

Developmental Competence: Pregnancy

Answer 7

breast change during second month (common)

enlargement/feels more nodular

increased vascularity

Question 8

Developmental Competence: The Aging Adult

Answer 8

post-menopause

ovarian secretion of estrogen and progesterone decreases

decreased breast size and elasticity (subq tissue atrophies)

Question 9

Collecting Objective Data: Inspection

Answer 9

Appearance of skin (smooth and even tone)

Size and symmetry (slightly asymmetrical is normal)

Contour

Characteristics of nipples

Question 10

Collecting Objective Data: Positioning for Retraction Screening

Answer 10

arms at side, arms above head, hands on hips, leaning forward

retraction could be sign of fibrosis

Question 11

Collecting Objective Data: Inspect and Palpate Axillae

Answer 11

note rashes or discoloration

palpate in directions

• down chest wall from central axilla
• anterior border of axilla
• posterior border of axilla
• inner aspect of inner arm

Question 12

Collecting Objective Data: Palpating Breasts

Answer 12

supine position is most beneficial

follow vertical strip pattern best for detecting lumps

Question 13

Collecting Objective Data: What to note when detecting lumps

Answer 13

location
size
shape
consistency
movable
distinctness
nipple
tenderness

BREAST (more advanced cancer)
breast mass
retraction
edema
axillary mass
scaly nipple
tender breast

Question 14

Breast Cancer (modifiable risk factors)

Answer 14

nulliparity (no natural born child) or first child after 30 y/o
current use of oral contraceptive
long-term use of HRT
not breast feeding
alcohol intake 2-5 drinks daily
obesity (especially after menopause)
physical inactivity

Question 15

Breast Cancer (non-modifiable)

Answer 15

first-degree relatives of breast cancer pt who were diagnoses premenopausal and had bilateral disease
female >50 y/o
personal history
BRCA1 or BRCA2 gene mutation (breast cancer gene)
hx of hyperplasia (enlargement) on biopsy
menarche before 12y/op
menopause after 50 y/o
white race (higher risk)

Question 16

Palpable Masses (15-25 y/o)

Answer 16

fibroadenoma - fine, round, mobile, nontender

Question 17

Palpable Masses (25-50 y/o)

Answer 17

cysts - soft to firm, round, mobile, often tender

fibrocystic changes - nodular, ropelike

cancer - irregular, firm

Question 18

Palpable Masses (>50 y/o)

Answer 18

Cancer until proven otherwise - irregular, firm

Question 19

Male Breast (assessment)

Answer 19

inspect chest wall
palpate nipple area
palpate axillary lymph nodes

gynecomastia - benign growth of male breast tissue

cancer is rare but possible

Question 20

Nursing Diagnoses

Answer 20

disturbing body image
grieving
ineffective coping