CH 19 breast an axillae assessment Flashcards
How is the breast divided and identified by
The breast is divided and identified by four quadrants by horizontal and vertical lines that intersect at the nipple
Where is the tale of Spence and what is so important about the tail of spence
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
Where is the nipple located and what is it composed of
What is the Ariola, where is it located, what is it made of
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

What is the location of the pectoralis major muscles in relation to the breast
(Give specifics, rib numbers)
Pectoralis major muscles located posterior to retromammory layer and line chest wall from 2nd to 6 rib from sternum to axillae
What is the location of pectoralis minor
Pectoralis minor is located posterior to pectoralis major
What are the Montgomery glands and what do they secrete
Montgomery Gladss are small sebaceous glands on areola surface that secrete a Protectiveoily substance during lactation
What type of tissue is the axillary tail of Spence part of And where is it located
The actuary tale of Spence is part of the mammory tissue
Extends from upper outer quadrant to axillae
Where are the ribs located
What are the ribs considered in relation to lumps
Ribs are located posterior to pectoralis muscle
The ribs are often the most palpable finding mistaken for lumps
Give the anatomical position of the breast including rib numbers
The breast itself is superior to the 7th rib inferior to the 1st/2nd rib
What nerve innervates the breast
The right and left intercostal nerves innervate each breast
What are the axillae and lymph notes considered in relation to the breast
Axillae and lymph nodes are considered extensive lymphatic superficial networks for draining
Give the other name for the lateral axillaryand its  location 
Lateral axillary =bronchial nodes
Located inside the upper arm along humerus
Give the other name for the central axillary and where they are located
Central axillary= mid axillary node‘s
Located up in axillae at the top of the ribs against the chest wall
Give the other name for the posterior axillary and its location
Posterior axillary = sub scapular nodes
Located inside posterior axillary folds along lateral edge of scapula

Give the other name for the anterior axillary
Anterior axillary= pectoral nodes
Located inside axillary fold along pectoralis major
How is breast cancer spread
What are characteristics of a cancer is lymph node
Breast cancer spread through the lymphatic system
Characteristics include:
-  +1cm
- fixed (doesn’t move)
- hard (form)
- palpable
- nontender
- irregular border
What are characteristics of an infected lymph node
Infected lymph nodes characterized by
- enlarged (palpable)
- tender
- warm
Why does breast tenderness occur with oral contraceptives
Breast tenderness occurs with oral contraceptives because of an increase in estrogen
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
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
What is colostrum what does it contain and what should you do with colostrum
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
What are two normal findings in newborns and infants in relation to the breasts and nipples
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
What is used to stage the development of breasts in children and adolescents up to adults
How do breasts develop
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
What are brush changes associated with menarche
Breasts become full, sore, heavy just prior to mensies
What is a normal lifespan consideration for postmenopausal older women and why
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
What is a life span consideration you see in men in relation to the breasts
And why does this develop
Men develop gynecomastia which is breast enlargement
As a result of:
- obesity
- decrease testosterone (androgen)
- anabolic use
- smoky marijuana
What is a cultural consideration among African-Americans
African-Americans immature earlier than Caucasians in relation to the breasts
Who has the lowest incidence in cancer
Asians and pacific islanders have the lowest cancer incidence
Who has the poorest outcome when it comes to cancer especially of the breast and why
African-Americans and Mexicans have the porrest outcomes when it comes to cancer especially other breasts because of delay of treatment
Describe the stages of Tanner‘s staging of breast development
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
As an urgent assessment what are conditions in relation to the nipple that need further investigation
Multiple
-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
What does it mean when a woman has brown spots on the inner portion of the bra
What type of assessment is required
Brown spots on the inner portion of the bra is bleeding of the nipple (nipple discharge) and it is an emergent assessment
What breast do you palpate first when inspecting for Leominster mass is
Do you palpate the unaffected breast first to know the patient’s normal breast tissue
What is the most common cancer amung woman in the US
Breast cancer
When assessing risk factors for personal history what are two very important things you want to ask the patient
If they have had any previous surgery or nipple discharge
Name modifiable lifestyle related breast cancer risk factors and personal habits
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
In relation to breast-feeding how do you decrease your risk of breast cancer
Breast-feeding 1 1/2 to 2 years decreases risk of breast cancer
Name nonmodifiable factors for breast cancer risks
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)
When is it suggested to start getting a mammogram
Between the ages of 45 to 55 years of age
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
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)
What are medication that pose risk factors for breast cancer and why birth control
- Androgens (hormones)
- antidepressants
- antipsychotics
- cardiac glycosides
- birth control
- because the increase in estrogen causes enlargement/ tenderness
Who is considered first-degree blood relatives who are considered second-degree blood relative
1st degree: mom sister
2nd degree: aunt Grandma
What are the health goals related to risk reduction and health promotion for breast and Axillae assessments
- increase proportion of moms who breast-feed
- Reduce female breast cancer death rate by 10%
—-INCREASE # OF CA SURVIORS WHO LIVE 5YRS + - Reduce late stage female breast cancer
- AA AND HISPANICS 
As far as risk reduction when should you start doing self breast exams and how often
Begins self breast exams at age 20
Deuce of breast exam monthly plus annual exam
What is the medical term for breast pain
What do you wanna get if a patient presents with mystalgia
Mastolgia 
If patient presents with mastalgia get complete pain assessment
OLDCART

Give common breast an axillary symptoms
Breast pain
rash
lumps/swelling
nipple discharge/trauma
If a woman presents with a rash on her breasts what do you want to do
If presented with rash determine the type of rash as it could be caused by contact dermatologist due to bra
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
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
How do you check bloody for nipple discharge
To check for bloody nipple discharge check the inside of the bra for a brown tinge
What are expected breast changes associated with breast-feeding
Common misconception, infection
- 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
What must you keep in mind with adolescent girls when examining their breasts
How do you want to accommodate your assessment for adolescent girls
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
How do you best accentuate any dimpling or retraction of the breast and why
(Ligaments)
To accentuate dimpling/retraction have patient lift arms above her while sitting is it extension to the suspensory ligament
When doing a clinical breast exam what is vital to do as you’re conducting the examination
- Tell patient what you’re going to doto avoid embarrassment
- Palpate, provide privacy, and drape
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
When inspecting it is vital to compare both breasts
Positions
- Sit with arms at side
- Lift arms up
- Place arms on hips
- Lean forward at the waist
-  lay supine one arm up pillow under breast
When you are palpating the nodule was what are you palpating for specifically which node
On palpation your palpating for lymphadenopathy specifically in the lateral axillae (brachial notes)
- inside upper arm along humorous
and all notes
With inspection give a few things you were looking for
Color texture Size/ shape symmetry dimpling retractions in/eversion drainage
What breast is likely to be slightly larger
The LEFT Breast is likely to be slightly larger
What is accentuated by having the woman put her arms over her head during the clinical breast examination
By putting arms overhead you can accentuate any dipling or retraction present
What does leaning forward from the waise Reveal about the breast nipple
Leaning forward from the waist reveals breast or nipple asymmetry
We’re doing a post mistakeed me examination what is the procedure you were going to follow
1st: palpate surgical scar and chest wall using two finger pads in a circular motion for any changes
What are medications that can contribute to gynocomastia 
What exactly causes gynecomastia
Antidepressants
Antipsychotics
Cardiac glycosides
Progestin
- similar to medication risk factors for women
Gynecomastia results from changing of hormone levels
When inspecting and encountering peau d’orange what does it indicate
What causes paeu d’ orange
peau d’ orange = Advanced breast cancer
peau d’ orange caused by breast Adema of blocked lymphoid drainage
What can nipple retractions or dimpling indicate
Nipple retractions or dipling can indicate cancer
What are two ways carcinomas can present on breast tissue
- Skin areola and nipple retraction
2. Bulging of breast and skin changes including erythema
What is Paget’s disease on the breast also known as and how does it present
What kind of cancer is Paget’s disease
Paget’s disease AKA (follicular keratosis)
Presents as:
-scaly red rash on the nipple and Ariola
Is a rare form of breast cancer
Describe mastitis
Mastitis is the information from a blocked milk duct because of lactation found postpartum
Is red warm and inflamed/infected
Give the technique for palpating of the axilla
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
How do you palpate a breast or axilla
Palpate with finger pads in small concentric circles
When do you use the bimanual technique and what is the technique
By manual technique used for pendulous breast (large)
Use two hands one under and one over gently compressing 
When laying a patient supine what else must you instruct the patient to do
When laying supine have patient put arm behind head and give a pillow roll towel under dislike being examined to flatten the breast
What is the best technique for Palpation
What are other methods of palpation
The vertical strip pattern is the best technique for palpation backed by evident because it covers the entire breast area
Other methods:
- Circular
- Wedge
When would you palpate the nipple
Upon palpation if discharge present what do you get
What is the normal findings of a nipple
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
What is vital to know about patience and medication
What are medications that can cause clear liquid discharge
It’s fun to know what medications the patient is on
Steroids
Calcium channel blockers
Birth control
Tranquilizers
Describe the technique of transillumination
Fluid ans non fluid filled
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
When assessing post mastectomy what are you assessing what are you looking for and what do you always want to check
Post mastectomy exam assessing scar
Look for signs and symptoms of infection
Always check patients back for bleeding
When does milk production typically start for lactating women
Milk production typically starts the third day postpartum
What stimulates increased milk production
How will breast appear postpartum
Frequent breast-feeding stimulates milk production
Breast will appear enlarged for the first few weeks postpartum
What are a few laboratory and diagnostic tests you would run if mass/nipple discharge
- Mammography/ultrasound
2. Biopsy by Needle aspiration or incisional
Give patient outcomes related to Breast and axillae assessments
Patient returns to previous social involvement
-Especially post mastectomy
Patient performs breast self-examination monthly
Give nursing interventions related to Breast and axillae assessment
Teach breast self examination encourage monthly performance
Allow privacy during breast examination
Give nursing diagnosis related to breast and Axillae assessment
Disturbed body image
Ineffective coping
Ineffective role performance
Ineffective grieving
