Exam 3 chapter 18 Flashcards
breasts lie anterior to which structures
pectoralis major and serratus anterior muscles
breasts are located between which ribs
2nd and 6th ribs
extending from side of the sternum to the midaxillary
tail of spence
superior lateral corner projects up and laterally into axilla
what surrounds the nipples
areola
Montgomery’s glands
small elevated sebaceous glands that secrete protective lipid material during lactation
Name the structures
1: Axillary tail of spence
2: adipose tissue
3: serratus anterior muscle
4: pectoralis major
5: montgomery glands
6: nipple
7: areola
Breast is composed what types of tissue
Glandular tissue
fibrous tissue including suspensory ligaments
adipose tissue
What are Cooper’s ligaments?
fibrous bands extending vertically from surface to attach on chest wall muscles
what is embedded in adipose tissue
lobes
how are the breasts divided
4 quadrants
which quadrant is the site of most breast tumors
outer qudrand
what does glandular tissue contain
10-20 lobes radiating from nipple, and these are composed of lobules
what are the groups of axillary nodes
central axillary nodes
pectoral (anterior)
subscapular (posterior)
lateral
drainage from central axillary nodes goes where
infraclavicular and supraclavicular
Name the structures
- supraclavicular
- infraclavicular
- lateral axillary
- central axillary
- subscapular (posterior axillary)
- pectoral (anterior axillary)
what are epidermal ridges or “milk lines”
lines present during embryonic life that curve down from axilla to groin bilaterally
What are the only structures present at birth?
supernumerary nipple
occasionally persists and is visbile along track of mammray ridge
What hormone stimulates breast changes?
what is this stage called?
estrogen
puberty
Tanner staging
5 stages of breast development are included as levels of sexual maturity
What is thelarche?
breast budding
thelarche precededs menarche by how long
about 2 years
breast apprearance during inital growth
may be asymmetrical
one may grow faster than the other
during pregnancy when do breast changes start
2nd month, typically an early sign for most women
thick yellow fluid is a precursor for milk
contains protein and lactose but minimal fat
colostrum
when is colostrum produced
the first few days after delivery
how long after delivery is colostrum produced
few days
why is colostrum/breastfeeding important
it is rish in antibodies to protect the newborn against infection
when does lactation begin
1-3 days postpartum
why does the breastmilk appear white
from emulsified and cacium caseinate
stage of life when ovarian production of estrogen and progesterone is decreased causing breast atrophy
post-menopausal
changes related to aging women
breast atrophy may cause a breast lump to be present
lactiferous ducts are more palpable and fell firm and stringy
axillary hari decreases
male breasts
rudimentary structure consisting of a thin disk of undeveloped tissure underlying nipple
gynecomastia
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
what genes should be assessed for risk of breast cancer
BRCA1 and BRCA2 mutation
lifestyle risk factors for breast cancer
alcohol dose-dependent effect
postmenopausal weight gain
decreased physical activity
culture and genetics: breast cancer nursing considerations
family history, ethnicity, environmental variables, access to healthcare, regular mammogram screenings
Subjective data for breasts
pain, lump, discharge, rash, swelling, trauma, hx of breast disease, surgery or radiation, meds, patient-centered care, self breast exams
subjective data for axilla
tenderness, lump, swelling, rash
Subjective data questions: pain
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)
Subjective data questions: lump
location
onset
appearance
change in overlying skin (redness, warmth, dimpling, swelling)
Subjective data questions: discharge
onset
characteristics (color, consistency, odor)
Subjective data questions: rash
appearance
onset
location
Subjective data questions: swelling
location
appearance (relating to menstrual period, pregnancy, breastfeeding)
change in bra size
Subjective data questions: trauma
any trauma or injury to the breast
presentation - swelling, lumo, or break in skin
Subjective data questions: history of breast disease
personal history of breast disease (what type)
medical management (treatment)
family history (who and what age)
Subjective data questions: surgery or radiation
what type of surgery?
results of biopsy
did you have radiation
results of imaging
Subjective data questions: medication
oral contraceptives? how long?
Hormone replacement therapy? how long?
types of meds (RX/OTC)
Considerations for Self breast exams
ask if they are performed
ensure teaching of the basics
review screening guidelines recommendations based on age and patient history
American Cancer society guidelines for self breast exams
begin at age 40-44, screening mammography
annual mammorgraphy 45-54
niennial mammography >55
questions to ask readolescent girls
changes in breast
to include onset, duration, and their perceptions
questions for ask pregnant women
enlargement/fullness of breast
tenderness/tingling
medical history (inverted nipples)
anticipatory planning: breastfeeding
questions to ask menopausal women
any changes in contour, size, firmness
second major cause of death from cancer in women
breast cancer
best way to increase survival rates in women with breast cancer
early detections and better treatment
breast cancer relative risks
relative risk >1 = higher liklihood of occurrence among exposed than unexposed persons
considerations for breast exam
short gown with an open back
uncover one breast at a time
be senstive but matter-of-fact
teach self breast exam after
equipment needed for a breast exam
small pillow
ruler marked in centimeters
pamphlet or teaching aid for self breast exam
general appearance of breasts
note symmetry of size and shape
(common to have a slight asymmetry in size)
general appearance: skin
smooth and even color
note localized reddness, bulging, dimpling, lesions, focal vascular patterns
no edema
changes to skin of the breast during pregnancy
fine blue vascular network visible
pale linear striae
inspection: lymphatic drainage areas
observe axillary and supraclavicular regions
note bulging, discoloration, edema
inspection: nipple
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
what position should the woman be in when examining axilla
seating
considerations for axilla inspection
support the arm to allow relaxation of muscles
move fingers firmly in four directions
move through entire ROM to increase surface area
best recommendation for palpation of breasts during an exam
vertical strip pattern
Two other common methods of palpation
from the nipple straight out to periphery
from the nipple using concentric circles out to periphery
normal breast tissue in a nulliparius woman
firm, smooth, and elastic
breast tissue after pregnancy
softer and looser
breast changes during premenstration
engorgement due to increased progesterone levels
what should be done if a woman mentions a breast lump that she has discovered
palpate the unaffected breast first to learn a baseline of normal
how should you proceed with the exam if a woman reports spontaneous nipple discharge
press arola inward with you index finger and repeat from a few different directions
note color and consistency of discharge
after palpating the breasts in all four quadrants what should you do
palpate the nipple and note any induration or subareolar mass
using thumb and forefinger gently depress nipple tissue into well behind areola
how to describe the location of a lump
using the face of a clock in comparison to the nipple
or using a diaphram and mark the location of the lump
How to measure the size of the lump
measure length, width, and thickness in centimeters
how to describe the shape of a breast lump
oval, round, lobulated, or indistinct
measure the consistency
soft, firm, hard
describe mobility of the lump
freely moveable or fixed when you slide it over chest wall
how to notate lump distinction
solitary or multiple
notate nipple characteristics
displaced or retracted
what to observe about the skin over the nipple
erythematous, dimpled, retracted
lymphadenopathy
any regional lymph nodes palpable
How to perform a self breast exam
key points in teaching self breast exam
keep it simple
report any abnormals
start by looking in the mirror
then do it in the shower
then do it supine
what is peau D’orange
lymphatic obstruction produces edema causing thickened skin and exaggerates hair follicles
what is peau d’orange indicative of
cancer
benign breast disease
creates lumpy ropelike texture
usually caused by hormonal changes
can be painful, tenderness, lumpiness
male breast cancer
rate: <1%
may have lump/swelling
red/flaky skin
irritation or dimpling
nipple discharge
pulling in of the nipple
