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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
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
26
What is a cultural consideration among African-Americans
African-Americans immature earlier than Caucasians in relation to the breasts
27
Who has the lowest incidence in cancer
Asians and pacific islanders have the lowest cancer incidence
28
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
29
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 ```
30
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
31
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
32
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
33
What is the most common cancer amung woman in the US
Breast cancer
34
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
35
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
36
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
37
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)
38
When is it suggested to start getting a mammogram
Between the ages of 45 to 55 years of age
39
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)
40
What are medication that pose risk factors for breast cancer and why birth control
1. Androgens (hormones) 2. antidepressants 3. antipsychotics 4. cardiac glycosides 5. birth control - because the increase in estrogen causes enlargement/ tenderness
41
Who is considered first-degree blood relatives who are considered second-degree blood relative
1st degree: mom sister 2nd degree: aunt Grandma
42
What are the health goals related to risk reduction and health promotion for breast and Axillae assessments
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
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
44
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 
45
Give common breast an axillary symptoms
Breast pain rash lumps/swelling nipple discharge/trauma
46
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
47
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
48
How do you check bloody for nipple discharge
To check for bloody nipple discharge check the inside of the bra for a brown tinge
49
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 ```
50
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
51
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
52
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
53
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 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
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
55
With inspection give a few things you were looking for
``` Color texture Size/ shape symmetry dimpling retractions in/eversion drainage ```
56
What breast is likely to be slightly larger
The LEFT Breast is likely to be slightly larger
57
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
58
What does leaning forward from the waise Reveal about the breast nipple
Leaning forward from the waist reveals breast or nipple asymmetry
59
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
60
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
61
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
62
What can nipple retractions or dimpling indicate
Nipple retractions or dipling can indicate cancer
63
What are two ways carcinomas can present on breast tissue
1. Skin areola and nipple retraction | 2. Bulging of breast and skin changes including erythema
64
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
65
Describe mastitis
Mastitis is the information from a blocked milk duct because of lactation found postpartum Is red warm and inflamed/infected
66
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
67
How do you palpate a breast or axilla
Palpate with finger pads in small concentric circles
68
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 
69
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
70
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
71
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
72
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
73
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
74
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
75
When does milk production typically start for lactating women
Milk production typically starts the third day postpartum
76
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
77
What are a few laboratory and diagnostic tests you would run if mass/nipple discharge
1. Mammography/ultrasound | 2. Biopsy by Needle aspiration or incisional
78
Give patient outcomes related to Breast and axillae assessments
Patient returns to previous social involvement -Especially post mastectomy Patient performs breast self-examination monthly
79
Give nursing interventions related to Breast and axillae assessment
Teach breast self examination encourage monthly performance Allow privacy during breast examination
80
Give nursing diagnosis related to breast and Axillae assessment
Disturbed body image Ineffective coping Ineffective role performance Ineffective grieving

Health Assessment (20 decks)

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