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Health Assessment > CH 19 breast an axillae assessment > Flashcards

CH 19 breast an axillae assessment Flashcards

1
Q

How is the breast divided and identified by

A

The breast is divided and identified by four quadrants by horizontal and vertical lines that intersect at the nipple

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2
Q

Where is the tale of Spence and what is so important about the tail of spence

A

The tail of Spence extends from the upper outer quadrant of the breast into the axillae

The tail of Spence is one of the most common places for breast cancer development

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3
Q

Where is the nipple located and what is it composed of

What is the Ariola, where is it located, what is it made of

A

Nipple located at center of breast
Composed of:
-erectile tissue
-small extretory ducks to drain milk

Areola is a pigmented skin that in circles in the nip
Composed of:
-smooth muscle tissue


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4
Q

What is the location of the pectoralis major muscles in relation to the breast

(Give specifics, rib numbers)

A

Pectoralis major muscles located posterior to retromammory layer and line chest wall from 2nd to 6 rib from sternum to axillae

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5
Q

What is the location of pectoralis minor

A

Pectoralis minor is located posterior to pectoralis major

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6
Q

What are the Montgomery glands and what do they secrete

A

Montgomery Gladss are small sebaceous glands on areola surface that secrete a Protectiveoily substance during lactation

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7
Q

What type of tissue is the axillary tail of Spence part of And where is it located

A

The actuary tale of Spence is part of the mammory tissue

Extends from upper outer quadrant to axillae

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8
Q

Where are the ribs located

What are the ribs considered in relation to lumps

A

Ribs are located posterior to pectoralis muscle

The ribs are often the most palpable finding mistaken for lumps

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9
Q

Give the anatomical position of the breast including rib numbers

A

The breast itself is superior to the 7th rib inferior to the 1st/2nd rib

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10
Q

What nerve innervates the breast

A

The right and left intercostal nerves innervate each breast

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11
Q

What are the axillae and lymph notes considered in relation to the breast

A

Axillae and lymph nodes are considered extensive lymphatic superficial networks for draining

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12
Q

Give the other name for the lateral axillaryand its  location 

A

Lateral axillary =bronchial nodes

Located inside the upper arm along humerus

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13
Q

Give the other name for the central axillary and where they are located

A

Central axillary= mid axillary node‘s

Located up in axillae at the top of the ribs against the chest wall

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14
Q

Give the other name for the posterior axillary and its location

A

Posterior axillary = sub scapular nodes

Located inside posterior axillary folds along lateral edge of scapula



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15
Q

Give the other name for the anterior axillary

A

Anterior axillary= pectoral nodes

Located inside axillary fold along pectoralis major

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16
Q

How is breast cancer spread

What are characteristics of a cancer is lymph node

A

Breast cancer spread through the lymphatic system

Characteristics include:

  •  +1cm
  • fixed (doesn’t move)
  • hard (form)
  • palpable
  • nontender
  • irregular border
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17
Q

What are characteristics of an infected lymph node

A

Infected lymph nodes characterized by

  • enlarged (palpable)
  • tender
  • warm
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18
Q

Why does breast tenderness occur with oral contraceptives

A

Breast tenderness occurs with oral contraceptives because of an increase in estrogen

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19
Q

Why do breast changes happen in pregnant women

What are the breast changes at occur in two months

What are the breast changes that occur in four months

A

Breast changes in women occur because of placental hormones

2 months:

  • enlarged, tender
  • nipples darker, larger, erect
  • areloa enlarges and darkens
  • more mammory ducts

4 months:
-Colostrum produced
Prolactin secreted by pituitary gland stimulates lactation

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20
Q

What is colostrum what does it contain and what should you do with colostrum

A

Colostrum is breastmilk

Colostrum contains (is fortified with) high proteins, carbohydrates, and antibodies

Women should breast-feed babies because of the colostrum being fortified with antibodies

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21
Q

What are two normal findings in newborns and infants in relation to the breasts and nipples

A

breast:
-“witchs milk”
•newborns born with large breast that have white discharge
LIQUID WILL CLEAR UP

nips:
-supernumerary nipples
• accessory nipples associated with renal anomalies
-typically 4

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22
Q

What is used to stage the development of breasts in children and adolescents up to adults

How do breasts develop

A

Breast development staged with the tanner staging that is typically used around the age of 10 because that’s when breasts start to develop

One may develop faster than the other

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23
Q

What are brush changes associated with menarche

A

Breasts become full, sore, heavy just prior to mensies

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24
Q

What is a normal lifespan consideration for postmenopausal older women and why

A

In post menopausal older women you see

  • smaller nipples
  • breasts become more pendulous (droop and sag)

because of the suspensatory ligament relaxation
=
Relaxation of Cooper ligament

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25
Q

What is a life span consideration you see in men in relation to the breasts

And why does this develop

A

Men develop gynecomastia which is breast enlargement

As a result of:

  • obesity
  • decrease testosterone (androgen)
  • anabolic use
  • smoky marijuana
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26
Q

What is a cultural consideration among African-Americans

A

African-Americans immature earlier than Caucasians in relation to the breasts

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27
Q

Who has the lowest incidence in cancer

A

Asians and pacific islanders have the lowest cancer incidence

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28
Q

Who has the poorest outcome when it comes to cancer especially of the breast and why

A

African-Americans and Mexicans have the porrest outcomes when it comes to cancer especially other breasts because of delay of treatment

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29
Q

Describe the stages of Tanner‘s staging of breast development

A 
S1: pre-adolescent under 10 YOA 
S2: Breast bud stage: Areola widens
S3:Breast and areola enlarge
S4: Areola and nipple form secondary mound over breast
S5: Mature breast
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30
Q

As an urgent assessment what are conditions in relation to the nipple that need further investigation
Multiple

A

-New breast lump/overall swelling
• even if no distinct mess is felt

-skin irritation or dimpling in breast tissue/axillary area

-nipple discharge
• Brown spots on bra

  • nipple retraction
  • breast/nipple pain
  • Erythema, scaliness or thickening of nipple/breast skin
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31
Q

What does it mean when a woman has brown spots on the inner portion of the bra

What type of assessment is required

A

Brown spots on the inner portion of the bra is bleeding of the nipple (nipple discharge) and it is an emergent assessment

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32
Q

What breast do you palpate first when inspecting for Leominster mass is

A

Do you palpate the unaffected breast first to know the patient’s normal breast tissue

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33
Q

What is the most common cancer amung woman in the US

A

Breast cancer

34
Q

When assessing risk factors for personal history what are two very important things you want to ask the patient

A

If they have had any previous surgery or nipple discharge

35
Q

Name modifiable lifestyle related breast cancer risk factors and personal habits

A

Drinking alc

physical inactivity

overweight/obesity

history of childbirth
-(# or nulliparous)

First child before after 30

birth control

breast-feeding
- 1 1/2 -2 years decrease the risk of breast cancer

hormone replacement post menopause

36
Q

In relation to breast-feeding how do you decrease your risk of breast cancer

A

Breast-feeding 1 1/2 to 2 years decreases risk of breast cancer

37
Q

Name nonmodifiable factors for breast cancer risks

A

Age, gender, race (⬆️incidence in whites

family history (genes)

personal history of breast cancer

Abnormal breasts

period before 12 after 55 YOA

Previous chest radiation for other cancers

*** DES exposure
(A hormone given to decreased abortion incidents)

38
Q

When is it suggested to start getting a mammogram

A

Between the ages of 45 to 55 years of age

39
Q

When teaching how to do a self breast exam (SBE)

  • what do you want to teach those who still have mensies and why
  • What do you teach postmenopausal/men about self breast exams
A

You wanna teach those who still have their period to conduct SBE

  • 4–7 days from start of menstrual cycle which coincides with the end of the menstrual cycle
  • breasts are smallest and less congested

For those who are postmenopausal or men

-evaluate at the same time each month
(Jan 15-feb15)

40
Q

What are medication that pose risk factors for breast cancer and why birth control

A
  1. Androgens (hormones)
  2. antidepressants
  3. antipsychotics
  4. cardiac glycosides
  5. birth control
    - because the increase in estrogen causes enlargement/ tenderness
41
Q

Who is considered first-degree blood relatives who are considered second-degree blood relative

A

1st degree: mom sister

2nd degree: aunt Grandma

42
Q

What are the health goals related to risk reduction and health promotion for breast and Axillae assessments

A
  1. increase proportion of moms who breast-feed
  2. Reduce female breast cancer death rate by 10%
    —-INCREASE # OF CA SURVIORS WHO LIVE 5YRS +
  3. Reduce late stage female breast cancer
    - AA AND HISPANICS 
43
Q

As far as risk reduction when should you start doing self breast exams and how often

A

Begins self breast exams at age 20

Deuce of breast exam monthly plus annual exam

44
Q

What is the medical term for breast pain

What do you wanna get if a patient presents with mystalgia

A

Mastolgia 

If patient presents with mastalgia get complete pain assessment
OLDCART



45
Q

Give common breast an axillary symptoms

A

Breast pain
rash
lumps/swelling
nipple discharge/trauma

46
Q

If a woman presents with a rash on her breasts what do you want to do

A

If presented with rash determine the type of rash as it could be caused by contact dermatologist due to bra

47
Q

When assessing for lumps what can lumps be associated with

What is the sign of a cancerous lump

What can swelling in breast correspond to

A

Breast lumps can be associated with fibrocystic cysts
-a normal lumpy and rope like texture to breasts
: which are tender especially before mensies

CA lumps: +1 cm fixed, hard, firm, palpable

Swelling in the breast can be cyclical corresponding to menstrual cycle

48
Q

How do you check bloody for nipple discharge

A

To check for bloody nipple discharge check the inside of the bra for a brown tinge

49
Q

What are expected breast changes associated with breast-feeding
Common misconception, infection

A
  • breast-feeding provides increased antibodies for baby
  • inverted nipple breast-feeding can happen
-mastitis an infection postpartum due to a clogged breast milk duct will present as: 
    • Swollen 
    •red  
    •painful 
    •purulent discharge
50
Q

What must you keep in mind with adolescent girls when examining their breasts

How do you want to accommodate your assessment for adolescent girls

A

Add listen girls have body image issues as they are in the identity of the real confusion stage

  • Expose what you need drape as you go
  • Assess one breast at a time
  • Use Tanner scale to teach one breast grows larger than the other
51
Q

How do you best accentuate any dimpling or retraction of the breast and why

(Ligaments)

A

To accentuate dimpling/retraction have patient lift arms above her while sitting is it extension to the suspensory ligament

52
Q

When doing a clinical breast exam what is vital to do as you’re conducting the examination

A
  • Tell patient what you’re going to doto avoid embarrassment

- Palpate, provide privacy, and drape

53
Q

As you are inspecting the breasts what is vital to do between the two breasts

What are the positions you want the woman to assume for inspection leading into palpation

A

When inspecting it is vital to compare both breasts

Positions

  1. Sit with arms at side
  2. Lift arms up
  3. Place arms on hips
  4. Lean forward at the waist
  5.  lay supine one arm up pillow under breast
54
Q

When you are palpating the nodule was what are you palpating for specifically which node

A

On palpation your palpating for lymphadenopathy specifically in the lateral axillae (brachial notes)
- inside upper arm along humorous

and all notes

55
Q

With inspection give a few things you were looking for

A 
Color
texture
Size/ shape
symmetry
dimpling
retractions
in/eversion 
drainage
56
Q

What breast is likely to be slightly larger

A

The LEFT Breast is likely to be slightly larger

57
Q

What is accentuated by having the woman put her arms over her head during the clinical breast examination

A

By putting arms overhead you can accentuate any dipling or retraction present

58
Q

What does leaning forward from the waise Reveal about the breast nipple

A

Leaning forward from the waist reveals breast or nipple asymmetry

59
Q

We’re doing a post mistakeed me examination what is the procedure you were going to follow

A

1st: palpate surgical scar and chest wall using two finger pads in a circular motion for any changes

60
Q

What are medications that can contribute to gynocomastia 

What exactly causes gynecomastia

A

Antidepressants
Antipsychotics
Cardiac glycosides
Progestin

  • similar to medication risk factors for women

Gynecomastia results from changing of hormone levels

61
Q

When inspecting and encountering peau d’orange what does it indicate

What causes paeu d’ orange

A

peau d’ orange = Advanced breast cancer

peau d’ orange caused by breast Adema of blocked lymphoid drainage

62
Q

What can nipple retractions or dimpling indicate

A

Nipple retractions or dipling can indicate cancer

63
Q

What are two ways carcinomas can present on breast tissue

A
  1. Skin areola and nipple retraction

2. Bulging of breast and skin changes including erythema

64
Q

What is Paget’s disease on the breast also known as and how does it present

What kind of cancer is Paget’s disease

A

Paget’s disease AKA (follicular keratosis)

Presents as:
-scaly red rash on the nipple and Ariola

Is a rare form of breast cancer

65
Q

Describe mastitis

A

Mastitis is the information from a blocked milk duct because of lactation found postpartum

Is red warm and inflamed/infected

66
Q

Give the technique for palpating of the axilla

A

Have patient in sitting position

Have patient gently rest arm and you support to aid in muscle relaxation

Palpate Central Notes
-High in axilla top of ribs against chest wall

Note any characteristics for cancerous lymph nodes: +1 cm, fixed, firm, hard

67
Q

How do you palpate a breast or axilla

A

Palpate with finger pads in small concentric circles

68
Q

When do you use the bimanual technique and what is the technique

A

By manual technique used for pendulous breast (large)

Use two hands one under and one over gently compressing 

69
Q

When laying a patient supine what else must you instruct the patient to do

A

When laying supine have patient put arm behind head and give a pillow roll towel under dislike being examined to flatten the breast

70
Q

What is the best technique for Palpation

What are other methods of palpation

A

The vertical strip pattern is the best technique for palpation backed by evident because it covers the entire breast area

Other methods:

  • Circular
  • Wedge
71
Q

When would you palpate the nipple

Upon palpation if discharge present what do you get

What is the normal findings of a nipple

A

You palpate the nipple if discharge is present

When palpating if discharge is present collect a sample

Normal nipple findings: are smooth without masses nodules or discharge

72
Q

What is vital to know about patience and medication

What are medications that can cause clear liquid discharge

A

It’s fun to know what medications the patient is on

Steroids
Calcium channel blockers
Birth control
Tranquilizers

73
Q

Describe the technique of transillumination

Fluid ans non fluid filled

A

In a dark room with a strong light press the light up against a mass

  • If fluid filled: like will pass through
  • if solid mass light will not pass through indicating tumor
74
Q

When assessing post mastectomy what are you assessing what are you looking for and what do you always want to check

A

Post mastectomy exam assessing scar

Look for signs and symptoms of infection

Always check patients back for bleeding

75
Q

When does milk production typically start for lactating women

A

Milk production typically starts the third day postpartum

76
Q

What stimulates increased milk production

How will breast appear postpartum

A

Frequent breast-feeding stimulates milk production

Breast will appear enlarged for the first few weeks postpartum

77
Q

What are a few laboratory and diagnostic tests you would run if mass/nipple discharge

A
  1. Mammography/ultrasound

2. Biopsy by Needle aspiration or incisional

78
Q

Give patient outcomes related to Breast and axillae assessments

A

Patient returns to previous social involvement
-Especially post mastectomy

Patient performs breast self-examination monthly

79
Q

Give nursing interventions related to Breast and axillae assessment

A

Teach breast self examination encourage monthly performance

Allow privacy during breast examination

80
Q

Give nursing diagnosis related to breast and Axillae assessment

A

Disturbed body image
Ineffective coping
Ineffective role performance
Ineffective grieving

Health Assessment (20 decks)

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