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Physical Assessment > Exam 3 chapter 18 > Flashcards

Exam 3 chapter 18 Flashcards

1
Q

breasts lie anterior to which structures

A

pectoralis major and serratus anterior muscles

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2
Q

breasts are located between which ribs

A

2nd and 6th ribs
extending from side of the sternum to the midaxillary

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3
Q

tail of spence

A

superior lateral corner projects up and laterally into axilla

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4
Q

what surrounds the nipples

A

areola

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5
Q

Montgomery’s glands

A

small elevated sebaceous glands that secrete protective lipid material during lactation

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6
Q

Name the structures

A

1: Axillary tail of spence
2: adipose tissue
3: serratus anterior muscle
4: pectoralis major
5: montgomery glands
6: nipple
7: areola

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7
Q

Breast is composed what types of tissue

A

Glandular tissue

fibrous tissue including suspensory ligaments

adipose tissue

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8
Q

What are Cooper’s ligaments?

A

fibrous bands extending vertically from surface to attach on chest wall muscles

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9
Q

what is embedded in adipose tissue

A

lobes

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10
Q

how are the breasts divided

A

4 quadrants

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11
Q

which quadrant is the site of most breast tumors

A

outer qudrand

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12
Q

what does glandular tissue contain

A

10-20 lobes radiating from nipple, and these are composed of lobules

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13
Q

what are the groups of axillary nodes

A

central axillary nodes

pectoral (anterior)

subscapular (posterior)

lateral

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14
Q

drainage from central axillary nodes goes where

A

infraclavicular and supraclavicular

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15
Q

Name the structures

A
  1. supraclavicular
  2. infraclavicular
  3. lateral axillary
  4. central axillary
  5. subscapular (posterior axillary)
  6. pectoral (anterior axillary)
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16
Q

what are epidermal ridges or “milk lines”

A

lines present during embryonic life that curve down from axilla to groin bilaterally

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17
Q

What are the only structures present at birth?

A
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18
Q

supernumerary nipple

A

occasionally persists and is visbile along track of mammray ridge

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19
Q

What hormone stimulates breast changes?

what is this stage called?

A

estrogen

puberty

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20
Q

Tanner staging

A

5 stages of breast development are included as levels of sexual maturity

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21
Q

What is thelarche?

A

breast budding

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22
Q

thelarche precededs menarche by how long

A

about 2 years

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23
Q

breast apprearance during inital growth

A

may be asymmetrical

one may grow faster than the other

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24
Q

during pregnancy when do breast changes start

A

2nd month, typically an early sign for most women

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25
Q

thick yellow fluid is a precursor for milk

contains protein and lactose but minimal fat

A

colostrum

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26
Q

when is colostrum produced

A

the first few days after delivery

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27
Q

how long after delivery is colostrum produced

A

few days

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28
Q

why is colostrum/breastfeeding important

A

it is rish in antibodies to protect the newborn against infection

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29
Q

when does lactation begin

A

1-3 days postpartum

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30
Q

why does the breastmilk appear white

A

from emulsified and cacium caseinate

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31
Q

stage of life when ovarian production of estrogen and progesterone is decreased causing breast atrophy

A

post-menopausal

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32
Q

changes related to aging women

A

breast atrophy may cause a breast lump to be present

lactiferous ducts are more palpable and fell firm and stringy

axillary hari decreases

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33
Q

male breasts

A

rudimentary structure consisting of a thin disk of undeveloped tissure underlying nipple

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34
Q

gynecomastia

A

during adolescence it is common for breast tissue to temporarily enlarge

usually unliateral and temporary, must reassure it is normal typically during puberty

may reappear in aging male due to testosterone deficiency

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35
Q

what genes should be assessed for risk of breast cancer

A

BRCA1 and BRCA2 mutation

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36
Q

lifestyle risk factors for breast cancer

A

alcohol dose-dependent effect

postmenopausal weight gain

decreased physical activity

37
Q

culture and genetics: breast cancer nursing considerations

A

family history, ethnicity, environmental variables, access to healthcare, regular mammogram screenings

38
Q

Subjective data for breasts

A

pain, lump, discharge, rash, swelling, trauma, hx of breast disease, surgery or radiation, meds, patient-centered care, self breast exams

39
Q

subjective data for axilla

A

tenderness, lump, swelling, rash

40
Q

Subjective data questions: pain

A

pain/tenderness in breasts - onset

painful sport

is the pain cyclical (any relation to menstrual cycle)

location - localized or diffuse

precipitating factors (strenuos activity, change in activity, sexual manipulation)

41
Q

Subjective data questions: lump

A

location

onset

appearance

change in overlying skin (redness, warmth, dimpling, swelling)

42
Q

Subjective data questions: discharge

A

onset

characteristics (color, consistency, odor)

43
Q

Subjective data questions: rash

A

appearance

onset

location

44
Q

Subjective data questions: swelling

A

location

appearance (relating to menstrual period, pregnancy, breastfeeding)

change in bra size

45
Q

Subjective data questions: trauma

A

any trauma or injury to the breast

presentation - swelling, lumo, or break in skin

46
Q

Subjective data questions: history of breast disease

A

personal history of breast disease (what type)

medical management (treatment)

family history (who and what age)

47
Q

Subjective data questions: surgery or radiation

A

what type of surgery?

results of biopsy

did you have radiation

results of imaging

48
Q

Subjective data questions: medication

A

oral contraceptives? how long?

Hormone replacement therapy? how long?

types of meds (RX/OTC)

49
Q

Considerations for Self breast exams

A

ask if they are performed

ensure teaching of the basics

review screening guidelines recommendations based on age and patient history

50
Q

American Cancer society guidelines for self breast exams

A

begin at age 40-44, screening mammography

annual mammorgraphy 45-54

niennial mammography >55

51
Q

questions to ask readolescent girls

A

changes in breast

to include onset, duration, and their perceptions

52
Q

questions for ask pregnant women

A

enlargement/fullness of breast

tenderness/tingling

medical history (inverted nipples)

anticipatory planning: breastfeeding

53
Q

questions to ask menopausal women

A

any changes in contour, size, firmness

54
Q

second major cause of death from cancer in women

A

breast cancer

55
Q

best way to increase survival rates in women with breast cancer

A

early detections and better treatment

56
Q

breast cancer relative risks

A

relative risk >1 = higher liklihood of occurrence among exposed than unexposed persons

57
Q

considerations for breast exam

A

short gown with an open back

uncover one breast at a time

be senstive but matter-of-fact

teach self breast exam after

58
Q

equipment needed for a breast exam

A

small pillow

ruler marked in centimeters

pamphlet or teaching aid for self breast exam

59
Q

general appearance of breasts

A

note symmetry of size and shape

(common to have a slight asymmetry in size)

60
Q

general appearance: skin

A

smooth and even color

note localized reddness, bulging, dimpling, lesions, focal vascular patterns

no edema

61
Q

changes to skin of the breast during pregnancy

A

fine blue vascular network visible

pale linear striae

62
Q

inspection: lymphatic drainage areas

A

observe axillary and supraclavicular regions

note bulging, discoloration, edema

63
Q

inspection: nipple

A

symmetrically in the same plane

note if nipples protrude, flat, or inverted

dry scaling, fissure or ulceration, bleeding or discharge

supernumerary nipple is normal variation

64
Q

what position should the woman be in when examining axilla

A

seating

65
Q

considerations for axilla inspection

A

support the arm to allow relaxation of muscles

move fingers firmly in four directions

move through entire ROM to increase surface area

66
Q

best recommendation for palpation of breasts during an exam

A

vertical strip pattern

67
Q

Two other common methods of palpation

A

from the nipple straight out to periphery

from the nipple using concentric circles out to periphery

68
Q

normal breast tissue in a nulliparius woman

A

firm, smooth, and elastic

69
Q

breast tissue after pregnancy

A

softer and looser

70
Q

breast changes during premenstration

A

engorgement due to increased progesterone levels

71
Q

what should be done if a woman mentions a breast lump that she has discovered

A

palpate the unaffected breast first to learn a baseline of normal

72
Q

how should you proceed with the exam if a woman reports spontaneous nipple discharge

A

press arola inward with you index finger and repeat from a few different directions

note color and consistency of discharge

73
Q

after palpating the breasts in all four quadrants what should you do

A

palpate the nipple and note any induration or subareolar mass

using thumb and forefinger gently depress nipple tissue into well behind areola

74
Q

how to describe the location of a lump

A

using the face of a clock in comparison to the nipple

or using a diaphram and mark the location of the lump

75
Q

How to measure the size of the lump

A

measure length, width, and thickness in centimeters

76
Q

how to describe the shape of a breast lump

A

oval, round, lobulated, or indistinct

77
Q

measure the consistency

A

soft, firm, hard

78
Q

describe mobility of the lump

A

freely moveable or fixed when you slide it over chest wall

79
Q

how to notate lump distinction

A

solitary or multiple

80
Q

notate nipple characteristics

A

displaced or retracted

81
Q

what to observe about the skin over the nipple

A

erythematous, dimpled, retracted

82
Q

lymphadenopathy

A

any regional lymph nodes palpable

83
Q

How to perform a self breast exam

A
84
Q

key points in teaching self breast exam

A

keep it simple

report any abnormals

start by looking in the mirror

then do it in the shower

then do it supine

85
Q

what is peau D’orange

A

lymphatic obstruction produces edema causing thickened skin and exaggerates hair follicles

86
Q

what is peau d’orange indicative of

A

cancer

87
Q

benign breast disease

A

creates lumpy ropelike texture

usually caused by hormonal changes

can be painful, tenderness, lumpiness

88
Q

male breast cancer

A

rate: <1%

may have lump/swelling

red/flaky skin

irritation or dimpling

nipple discharge

pulling in of the nipple

Physical Assessment (3 decks)

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