Chapter 17: Breasts And Regional Lymph

Question 1

Breast is located

Answer 1

in front (anterior) to the pectoralis major and serratus, between 2nd/6th ribs, extend from sternum to midaxillary line

Question 2

Parts of the breast include

Answer 2

1. Tail of Spence
2. Nipple
3. Areola
4. Glandular tissue
5. Cooper’s Ligaments
6. Adipose Tissue

Question 3

Tail of Spence

Answer 3

Projects up and laterally into the axilla

Question 4

Nipple

Answer 4

Fought, round and usually protrudes - wrinkled and indented with tiny milk duct openings

Question 5

Stella

Answer 5

Surrounds the nipple, 1-2 cm radius

Question 6

Montogomery’s glands

Answer 6

Small elevated sebaceous glands.

Secrete a protective lipid material during lactation.

Question 7

Glandular tissue

Answer 7

Composed of lobules which consist of clusters of alveoli that produce milk

Question 8

Cooper’s ligaments

Answer 8

Fibrous bands that attach to chest wall muscles

Question 9

Regional Lymph of the breasts include

Answer 9

1. Centrally Axillary Nodes
2. Pectoral Nodes
3. Subscapular Nodes
4. Lateral Nodes
5. Parasternal Nodes
6. Intraclavicular

Question 10

Central Axillary Nodes are located where?

Answer 10

High up in the middle of the axilla

Question 11

Pectoral Nodes are located where?

Answer 11

Along the lateral edge of the pectoral is major muscle, just inside the anterior axillary fold

Question 12

Subscapular Nodes are located where?

Answer 12

Along the lateral edge of the scapula, deep in the posterior axillary fold

Question 13

Lateral Nodes are located where?

Answer 13

Along the humerus, inside the upper arm

Question 14

Parasternal Nodes are located where?

Answer 14

At the eternal edges

Question 15

Intraclavicular

Answer 15

Below the supraclavicular

Question 16

Male Breast

Answer 16

Usually underdeveloped tissue underlying the nipple

Question 17

Gynecomastia

Answer 17

Enlarged breast tissue in males, usually temporary and unilateral

Question 18

What information would a nurse gather when asking about Breast History (subjective data)?

Answer 18

• 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

Question 19

What does the nurse need to do during a Physical Exam/Assessment (objective data) of the breast?

Answer 19

1. Inspection
2. Screen for Retraction
3. Palpation
4. Discuss breast exam

Question 20

Inspection of the breast and regional lymph nodes include

Answer 20

1. Skin texture and color

2. Nipples

Question 21

When inspecting skin texture and color of the breast, note:

Answer 21

note any edema, bulging or dimpling

note any lesions or focal pattern

Question 22

When inspecting the nipple, note:

Answer 22

Symmetry, skin color, texture or lesions (inverted nipples may be a normal variation).
Note discharge.

Question 23

Supernumerary Nipple

Answer 23

• An extra nipple along the embryonic “milk line” on the thorax and abdomen
• it is a congenital finding

Question 24

Screening for Retraction

Answer 24

1. ask client to lift arms slowly over the head (breast should move symmetrically).
2. next ask client to place hands onto hips then 2 palms together – note dimpling, retraction(s)

Question 25

Palpation of the Breast and Regional Nodes

Answer 25

1. Palpation of axillae 2. Palpation of breasts 3. Palpation of nipple

Question 26

Palpation of Axillae

Answer 26

Place arm overhead and palpate entire axillary area (may perform in upright or supine position)

Question 27

Palpation of Breasts

Answer 27

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

Question 28

Palpation of the Nipple

Answer 28

- “milk” your fingers toward the nipple - repeat from different directions - gently squeeze nipple - note any discharge (color and consistency, test for blood)

Question 29

When discussing breast self-exam, encourage

Answer 29

Self care

Question 30

If a lump/mass is noted, note these characteristics:

Answer 30

``` 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 ```

Question 31

When inspecting the male breast, the nurse must do what?

Answer 31

1. Inspect chest wall - note skin surface and any swelling 2. Palpate for lumps/masses or any tissue enlargements 3. Palpate the axillary for lymph nodes 4. Discuss education - male breast cancer

Question 32

Male breast cancer

Answer 32

- Rare, about 1% of breast cancers - Males are often diagnosed later in the disease process. - Important to note changes and follow-up.