ch. 20 Breast Assessment Flashcards
subjective data collection
history of present concern COLDSPA, past health history, family history, lifestyle/health practices
breast function
paired mammary glands, produce/store milk (females), aid sexual stimulation
breast anatomy
pectoralis major, axillary tail of spence, areola, serrates anterior, nipple, montogomery’s glands
Internal anatomy of the breast is composed of
glandular tissue, fibrous tissue, adipose tissue. divided into four quadrants centered at nipple
Which quadrant has the most tumors?
upper outer quadrant
Glandular tissue
radiates from nipple, where milk is produced - functional part of breast
Fibrous tissue
suspensory ligaments or connective tissue that attach to chest wall muscles and support the tissue
Adipose tissue
subcutaneous fat that provides most of bulk of breast, determines size/shape
Lymph nodes that drain the breasts
supraclavicular, infraclavicular, lateral, central, posterior, anterior
Breast has extensive lymph drainage
more than 75% of body’s lymph drains into axillary nodes. don’t take bp on side of mastectomy
breast development (adolescent)
enlarge due to extensive fat deposition, early development linked to high BMI. tenderness common during growth, pubic hair develops, axillary hair two years after, menarche after beginning breast development
What stimulates breast changes?
estrogen
pregnancy
stimulates expansion of ductal system/supporting fatty tissue, breasts enlarge and feel more nodular, nipples grow larger/darker and more erectile, areolae never return to original color, venous pattern prominent
Preparing the client
sitting upright, assistant (witness), explain importance of exposure (drape when can), explain process. inspect, palpate
aging female
menopause = decrease in estrogen/progesterone, glandular tissue atrophy replaced w/ fibrous connective tissue, decreases breast size/elasticity, breasts decrease in firmness
Equipment
centimeter ruler, small pillow, gloves, specimen slide, client handout on breast self exam
Assessment technique
inspection, palpation
inspection
size/shape, color/texture, superficial venous patterns, retraction/dimpling, bilaterally color, size, shape, texture of areolae. bilaterally note size/directions of nipples
palpation
texture/elasticity, tenderness/temperature, masses, milky discharge normal only during pregnancy/lactation, mastectomy/lumpectomy site
What do you palpate for with masses?
size in cm, shape, mobility, consistency, tenderness
male breasts
inspect/palpate breasts, areolae, nipples, axillae. shouldn’t have swelling, nodules, ulceration. gynecomastia
Gynecomastia
development of breast tissue in males
When is tenderness common?
w/ ovulation/period. usually ovulate on day 13-17 of cycle.
Assessment
Note tenderness, lumps, bumps in breast or axilla. nipples may be flat or inverted - retraction = problem. can palpate up and down, concentric circles or spokes on a wheel. nulliparous women have firm smooth elastic breast tissue, after pregnancy = softer/looser. implants?
Vertical strip pattern
up and down, start high in axilla, palpate down
Axillae
inspect/palpate - no rash/infection, no palpable nodes or 1-2 small discrete nontender movable nodes in central area
Abnormalities noted on inspection
peau d’orange, Paget disease, retracted nipple, dimpling, retracted breast tissue, mastitis, mastectomy
Peau d’orange
orange peel appearance
Paget disease
intraductal carcinoma in the breast
Abnormalities on palpation
cancerous tumors, fibroadenomas, benign breast disease
Mastitis
inflammation of breast
Fibroadenoma
benign breast mass
Self breast exam (SBE)
teaches woman to know normal breast/detect changes
Cancer
usually solitary, unilateral, non-tender mass. as cancer progresses may be solid, hard, dense, fixed to underlying tissues. PAINLESS, usually in UOQ. firm and hard irregular axillary nodes, skin dimpling, nipple retraction, discharge
Doing a self breast exam
lying down - spread out breast tissue. right arm behind head, use three middle finger pads of opposite hand to feel for lumps, overlapping/dime-sized circular motions. move in up and down pattern starting on imaginary line from underarm to middle of sternum. feel down to ribs/up to clavicle. repeat on other side. look in mirror w/ hands on hips - changes in size/shape/contour/dimpling/redness/scaliness of nipple or skin. examine underarm while sitting w/ arm slightly raised
Which pattern is most effective?
up and down
What causes gynecomastia?
testosterone deficiency or too much estrogen
Obesity contributes to ____________ in girls
early puberty
Men have thin underdeveloped tissue under the _______
nipple
Do blacks or whites have earlier onset of breast development?
blacks
Who has higher incidence of breast cancer after 45?
whites
When does mammography screening begin?
age 40 unless family history
Who has higher incidence and death from breast cancer before 45?
blacks
What are some lifestyle factors contributing to higher breast cancer risk?
alcohol, birth control
What may reduce breast cancer risk?
physical activity
