Chapter 17: Breasts And Regional Lymph Flashcards
Breast is located
in front (anterior) to the pectoralis major and serratus, between 2nd/6th ribs, extend from sternum to midaxillary line
Parts of the breast include
- Tail of Spence
- Nipple
- Areola
- Glandular tissue
- Cooper’s Ligaments
- Adipose Tissue
Tail of Spence
Projects up and laterally into the axilla
Nipple
Fought, round and usually protrudes - wrinkled and indented with tiny milk duct openings
Stella
Surrounds the nipple, 1-2 cm radius
Montogomery’s glands
Small elevated sebaceous glands.
Secrete a protective lipid material during lactation.
Glandular tissue
Composed of lobules which consist of clusters of alveoli that produce milk
Cooper’s ligaments
Fibrous bands that attach to chest wall muscles
Regional Lymph of the breasts include
- Centrally Axillary Nodes
- Pectoral Nodes
- Subscapular Nodes
- Lateral Nodes
- Parasternal Nodes
- Intraclavicular
Central Axillary Nodes are located where?
High up in the middle of the axilla
Pectoral Nodes are located where?
Along the lateral edge of the pectoral is major muscle, just inside the anterior axillary fold
Subscapular Nodes are located where?
Along the lateral edge of the scapula, deep in the posterior axillary fold
Lateral Nodes are located where?
Along the humerus, inside the upper arm
Parasternal Nodes are located where?
At the eternal edges
Intraclavicular
Below the supraclavicular
Male Breast
Usually underdeveloped tissue underlying the nipple
Gynecomastia
Enlarged breast tissue in males, usually temporary and unilateral
What information would a nurse gather when asking about Breast History (subjective data)?
- Breast pain or tenderness
- Breast lumps, lumps or swelling in axillary area
- Nipple discharge (color, consistency, odor)
- Rash - including axillary and breast
- Breast swelling, change in bra size
- Trauma or injury to breast
- Hx of breast disease, family hx of breast disease (at what age did relative have breast disease and which relative)
- Hx of breast surgery or radiation (augmentation, reduction, biopsy, etc.)
- Self Care Behavior - monthly self breast exam, date of last mammogram
What does the nurse need to do during a Physical Exam/Assessment (objective data) of the breast?
- Inspection
- Screen for Retraction
- Palpation
- Discuss breast exam
Inspection of the breast and regional lymph nodes include
- Skin texture and color
2. Nipples
When inspecting skin texture and color of the breast, note:
note any edema, bulging or dimpling
note any lesions or focal pattern
When inspecting the nipple, note:
Symmetry, skin color, texture or lesions (inverted nipples may be a normal variation).
Note discharge.
Supernumerary Nipple
- An extra nipple along the embryonic “milk line” on the thorax and abdomen
- it is a congenital finding
Screening for Retraction
- ask client to lift arms slowly over the head (breast should move symmetrically).
- next ask client to place hands onto hips then 2 palms together – note dimpling, retraction(s)
Palpation of the Breast and Regional Nodes
- Palpation of axillae
- Palpation of breasts
- Palpation of nipple
Palpation of Axillae
Place arm overhead and palpate entire axillary area (may perform in upright or supine position)
Palpation of Breasts
supine position, arm overhead palpate breast tissue using one of two patterns (spokes on a wheel or concentric circles or vertical strip pattern), also include tail of spence in palpation
Palpation of the Nipple
- “milk” your fingers toward the nipple
- repeat from different directions
- gently squeeze nipple - note any discharge (color and consistency, test for blood)
When discussing breast self-exam, encourage
Self care
If a lump/mass is noted, note these characteristics:
A. Location - describe as a clock B. Size - in 3 dimensions (cm) C. Shape D. Consistency E. Movable F. Distinctness - is the lump solitary or multiple G. Nipple - is it displaced or retracted H. Note the skin over the lump - is it erythematous, dimpled or retracted I. Tenderness J. Lymphadenopathy
When inspecting the male breast, the nurse must do what?
- Inspect chest wall - note skin surface and any swelling
- Palpate for lumps/masses or any tissue enlargements
- Palpate the axillary for lymph nodes
- Discuss education - male breast cancer
Male breast cancer
- Rare, about 1% of breast cancers
- Males are often diagnosed later in the disease process.
- Important to note changes and follow-up.
