objective 17 Flashcards
1
Q
present in both males and females
are an accessory reproductive organ
produce milk for nourishing the newborn
A
mammary glands
2
Q
- Lie anterior to the pectoralis major and serratus anterior
muscles. - Located between the 2nd and 6th ribs
- Extend from the side of the sternum to midaxillary line
- Tail of Spence
A
breasts
3
Q
- Just below the center of the breast
- Rough, round, usually protuberant, surface looks wrinkled
- Indented with tiny milk duct openings
A
nipple
4
Q
- Surrounds the nipple, 1-2 cm radius
- Contains Montgomery glands
- Smooth muscle fibers that cause nipple erection when
stimulated
A
areola
5
Q
- Contains 15-20 lobes radiating from the nipple
- Lobes are composed of lobules
- Alveoli are within each lobule and produce milk
- Each lobe empties into a lactiferous duct
A
glandular tissue
6
Q
form a collecting duct system that converges at the nipple
A
lactiferous ducts
7
Q
located behind
the nipple) which are reservoirs for storing milk
A
ampullae
8
Q
- Fibrous bands that extend vertically from the surface to attach
on the chest wall muscles - Support breast tissue
- Become contracted in cancer of the breast (causes pits or
dimples in the overlying skin)
A
suspensory ligaments
9
Q
- Where the lobes are embedded
- Layers of subcutaneous and retromammary fat - provide most of
the bulk of the breast
A
adipose tissue
10
Q
what are the 4 quadrants of the breast?
A
upper outer
lower outer
upper inner
lower inner
11
Q
what are the 4 groups of axillary nodes present in the breasts?
A
central axillary node
pectoral
subscapular
lateral
12
Q
what are the developmental considerations for fetus?
A
- During embryonic life, “milk lines” are present.
- Supernumerary nipple - extra nipple may persist and is visible
somewhere along the track of the mammary ridge
13
Q
what are the developmental considerations for infants?
A
- At birth, the only breast structures present are lactiferous ducts within
the nipple - No alveoli have developed
- In neonates, breasts may be enlarged and visible due to maternal
estrogen, may secrete a clear or white fluid (“witch’s milk”) - Little change occurs until puberty
14
Q
what are the developmental considerations for adolescents?
A
- At puberty the estrogen hormones stimulate breast changes
- Breasts enlarge, duct system grows and branches, masses of small solid
cells develop at the duct endings (potential alveoli) - One breast may grow faster than the other
- Temporary asymmetry may cause distress, some reassurance is necessary
- Tenderness in the developing breast is common
- Age of onset varies widely
- Breasts develop in 5 stages according to Tanner staging (Table 18.1)
- Thelarche (beginning of breast development) precedes menarche
(beginning of menstruation) by about 2 years
15
Q
what are the developmental considerations for pregnency?
A
- Breast changes start during the second month
- Breasts enlarge and feel more nodular
- Nipples are darker, larger, and more erectile
- Areolae become larger and darker as pregnancy progresses
- Tubercles become more prominent
- Venous pattern is prominent over the skin surface
- After the 4th month, colostrum may be expressed
- Lactation begins 1-3 days postpartum
- Even in non-pregnant women, breasts change during the monthly
menstrual cycle due to hormones.
16
Q
what are the developmental considerations for older women?
A
- After menopause, secretion of estrogen and progesterone from the
ovaries decreases – atrophy of breast glandular tissue which is replaced
by fibrous connective tissue - Atrophy of the fat envelope – begins in the middle years and becomes
very apparent in the age range of 80’s to 90’s - Breasts sag and droop – due to decreased breast size and elasticity
(kyphosis accentuates this appearance) - Inner structures feel more prominent, thickening of the inframammary
ridge at the lower breast - Easier to palpate lumps in the older woman’s breast
- Decrease in axillary hair occurs
17
Q
what are the developmental considerations for male breasts?
A
- Rudimentary structure – thin disk of undeveloped tissue
underlying the nipple - Areola well developed, nipple very small
- Gynecomastia
- Breast tissue temporarily enlarges
- Usually unilateral and temporary
- Reassurance necessary due to body image concerns
- Occurs commonly in adolescence; may appear in older men
due to testosterone deficiency
18
Q
how do we prep for assessment breasts?
A
- Position the client sitting up and facing the examiner
- Use an alternative draping method – use a short gown,
open at the back, and lift it up to the woman’s shoulders
during inspection - During palpation – when the woman is supine, cover
one breast with the gown while examining the other
19
Q
what equipment do u need?
A
small pillow, cm ruler
20
Q
what are the normal and abnormal findings for general appearance of breasts?
A
- Common variation – slight asymmetry in size (left breast being slightly
larger than the right) - Abnormal – sudden increase in breast size of one breast indicates
inflammation or new growth
21
Q
what are the normal and abnormal findings of the skin of the breast?
A
- Normal: smooth, even colour, no lesions, no edema
- Variation: fine blue vascular network normally visible during pregnancy,
pale striae often follow pregnancy - Abnormal – hyperpigmentation, redness and inflammation, unilateral
dilated superficial veins in a non-pregnant woman, edema (peau
d’orange) - Peau d’orange – skin with an ‘orange peel’ appearance, caused by
edema
22
Q
what are the normal and abnormal findings of the nipple?
A
- Normal: symmetrical, same plane on the two breasts, protrusion
- Variation
- Some nipples are flat or inverted. It is important to determine if this is
a recent nipple inversion or if the inversion has been present for many
years/since puberty - Normal nipple inversion – can be unilateral or bilateral and usually the
nipple can be pulled out (it is not fixed) - Supernumerary nipple
- Abnormal: deviation in nipple pointing, recent nipple retraction (signifies
acquired disease), discharge (especially in the presence of a breast mass)
23
Q
what are the maneuvers to screen for retraction?
A
- Ask the female client to change positions for assessment of
skin retraction - Ask the client to lift her arms slowly over her head (both
breasts should move up symmetrically) - Ask the client to push her hands unto her hips
- Ask the client to push her two palms together
- These movements contract the pectoralis major muscle
- Both breasts are lifted slightly
- Note any signs of retraction
24
Q
what are the normal and abnormal findings of pendulous breasts?
A
- Abnormal: note any fixation to the chest wall or skin
retraction
25
Q
how do we inspect the axillae?
A
- Examine the female client while she is sitting
- Inspect the skin, noting any rash or infection
26
Q
how do we palpate the breasts?
A
- To position to the client, follow the guidelines below.
Positioning the client in this manner will help flatten the breast
tissue and displace it medially. This will make any significant
lumps feel more distinct (see Image A to right). - Place the client in a supine position
- Tuck a small pad under the side to be palpated
- Raise her arm over her head
- To palpate the breast (see Image B to right) :
- Use the pads of the first 3 fingers
- Make a gentle rotary motion on the breast
- Vary the pressure used
- The vertical strip pattern is currently recommended as
the best to detect a breast mass (see Image C to right): - Start high in the axilla and palpate down just lateral to the
breast. - Proceed in overlapping vertical lines, ending at the sternal
edge. - Two other patterns (spokes-on-a-wheel pattern and
concentric circles pattern) are used as well - Regardless of the pattern used, ensure to palpate the
every square cm of the breast and to examine the tail of
Spence high into the axilla. - Always be consistent and thorough in your approach
27
Q
what are the normal and abnormal findings of palpating the breasts?
A
- In nulliparous women, normal breast tissue feels firm,
smooth, and elastic - After pregnancy, tissue feels softer and looser
- Premenstrual engorgement from increasing progesterone
is normal - Normally feel a firm, transverse ridge of compressed
tissue in the lower quadrants – inframammary ridge - Do not confuse the inframammary ridge with an abnormal lump
- The inframammary ridge is especially noticeable in large breasts
28
Q
how do you palpate the nipples?
A
- The examiner uses the thumb and forefinger to gently depress the
nipple into the tissue well behind the areolar - The tissue should move inward easily
- If discharge occurs, press the areolar inward with the index finger
in a few different locations - Note the colour and consistency of any discharge
- Except during pregnancy and lactation, discharge is abnormal
- Blot discharge on a white gauze to assess the colour – test any
abnormal discharge for the presence of blood
29
Q
- Used for female clients with large, pendulous breasts
- Ask the client to sit up and lean forward
- Support the inferior part of the breast with one hand
and use the other to palpate the breast tissue against
the supporting hand
A
bimanual technique
30
Q
how do we palpate the axillae>
A
- Palpate the Axillae
- Lift the female client’s arm and support it so that her muscles
are loose and relaxed - Use the examiner’s right hand to palpate the left axilla for
tenderness or palpate the lymph nodes - The examiner should reach the fingers high into the axilla and
move them freely in 4 directions: - Down the chest wall in a line from the middle of the axilla
- Along the anterior border of the axilla
- Along the posterior border
- Along the inner aspect of the upper arm
31
Q
what are the normal and abnormal findings when palpating the axillae?
A
- Normal: nodes are not palpable, although the examiner may
feel a small non-tender node in the central group. Expect
some tenderness high up in the axilla - Abnormal: enlarged and tender lymph nodes (local infection
of the breast, arm or hand; breast cancer metastases)
32
Q
if a lump is found what do we do?
A
- Location
- Size
- Shape
- Consistency
- Moveable
- Distinctness
- Nipple
- Skin
- Tenderness
- Lymphadenopathy
33
Q
how do we examine the male breast?
A
- Examination can be more abbreviated – do not omit it
- Combine breast examination with examination of the
anterior thorax - Inspect the chest wall – note the skin surface, any
lumps or swelling - Palpate the nipple area for lumps or tissue enlargement
– no nodules should be present - Palpate the axillary lymph nodes
34
Q
what are the normal and abnormal findings in men>
A
- Normal male breast – flat disc of undeveloped breast tissue
beneath the nipple - Presence of gynecomastia, do not confuse it with an increase
in fatty tissue in obesity - Normal finding: In adolescent boys.
- Abnormal finding: Can occur with anabolic steroid use, some
medications, and some disease states
35
Q
what should females do?
A
- Inspect their breasts in front of a mirror while disrobed to the
waist - Learn how their breasts feel while in the shower where soap and
water assist palpation - Learn how their breasts feel when lying supine so that the breast
tissue is flattened - Encourage clients to demonstrate palpation of their breasts
so the examiner can assess for proper technique - Use a breast model when educating the client about breast
lumps- the client can learn what a lump may feel like
