Quiz #2 Breast, Thorax, Lungs Flashcards
Site on Breast of most breast tumors
Upper Outer Quadrant
4 groups of axillary nodes
1) Central axillary
2) Pectoral (anterior)
3) Subscapular (posterior)
4) Lateral
Breast development Onset
8-9 for African Americans, 10 for caucasians.
Beginning of breast development precedes menarche by how long?
2 years
When is colostrum is expressed?
From 4 months to first few days after delivery.
What changes in the nipples happen during pregnancy?
The areola becomes larger and darker
Bronchial (tracheal) sounds
High, loud sounds in the trachea and larynx. Harsh, hollow tubular.
Bronchovesicular sounds
Moderate pitch, moderate amplitude sounds over the major bronchi.
Vesicular sounds
Low, soft rustling sounds over the peripheral lung fields.
Reasons for absent or decreased breath sounds
- Bronchial tree obstruction- by secretions, mucus plug, foreign body
- Decreased force of inspired air- emphysema
- Hyperinflation, inhaled air does not make as much noise- emphysema
- Obstruction between lung and stethoscope- pleurisy, pleural thickening, pneumothorax or fluid in pleural lung space (pleural effusion)
Changes to respiratory system in the aging adult (8)
- Costal cartilages become more calcified, and thorax less mobile
- Respiratory muscle strength decreases
- Decreased elasticity in lungs- collapse and recoil less
- Decreased vital capacity
- Increased residual volume
- Decreased number of alveoli
- Lung base less ventilated
- Increased risk of dyspnea on exertion
Why do elderly have increased risk of postoperative pulmonary complications?
- Decreased ability to cough
- Loss of protective airway reflexes
- Increased secretions
Subjective data for thorax and lungs (7)
- Cough
- Shortness of breath
- Chest pain
- Hx of respiratory infection
- Smoking history
- Environmental exposure
- Patient centered care
Additional questions for aging adult on subject lung assessment (6)
- Any new SOB or fatigue
- Reduced activity level
- New immobility
- Weight change
- Falls
- Chest pain while breathing
Normal anteroposterior to transverse diameter ratio
.7 to .75
Barrel chest
When AP=TD, common in COPD due to hyperinflation of the lungs.
Reasons for increased breath sounds
Consolidation (pneumonia) or compression (fluid in intrapleural space- creates a dense lung area that enhances sound.
Coarse Crackles
popping sounds heard over inspiration when air collides with secretions in the trachea and bronchi. May occur due to pneumonia, pulmonary edema, fibrosis, terminally ill with decreased cough reflex
Wheezes
High pitched, musical squeaking sounds that predominate in expiration. Caused by compressed airways due to swelling, tumors, asthma, or emphysema
Characteristics to describe breath sounds
- Inspiration or Expiration
- Loudness
- Pitch
- Location
6 minute walk test
A person who walks >300m in 6 minutes is more likely to engage in ADL
Compensation for kyphosis
extending neck and tipping back head
Four functions of the respiratory system
- Provide oxygen to tissues
- Rid body of CO2/wastes
- Maintain homeostasis (acid/base balance)
- Maintain heat exchange
Where does most lymphatic drainage in the breast go?
The ipsilateral side (75%)
Changes in breasts in the aging adult
- Breast glandular tissue atrophies, replaced by fibrous connective tissue
- Drooping- may be accentuated by kyphosis
- Breast lumps may be more palpable.
Women who are less likely to have mammograms
- Less than a high school education
- No health insurance
- Recent immigrants
Subjective data for breast (12)
- Pain—PQRST, cyclical is common
- Lump— how long? Relationship to cycle?
- Discharge—color, consistency, odor
- Rash— where did it start?
- Swelling
- Trauma
- Hx of breast cancer
- Surgery/radiation
- Medications- OCP and combined hormonal therapy increases risk of breast cancer
- Axilla—assess for tenderness, swelling, lump
- Screening exams
- Teaching
Objective Data Breast
- Inspect breast
- Inspect & palpate axilla
- Palpate the breasts
- Teach BSE
Inspection of the breast
- General appearance- Inspect for redness, heat, vascular pattern, edema, discoloration
- Nipples- normally protrude, assess for discharge
- Lift arms over head, assess for retraction, lag in movement of one breast
Palpation of the axilla
- Down the chest wall from middle of the axilla
- Anterior axilla border
- Posterior axilla border
- Along inner upper arm
Breast lump
- Location- clock face and cm from nipple
- Size
- Shape
- Consistency
- Movable
- Distinctness
- Nipple- displaced or retracted
- Skin over lump- erythema, dimpled, retracted
- Tenderness
- Lymphadenopathy
Signs of advanced cancer
- Breast mass
- Retraction
- Edema- peu d’orange
- Axillary mass
- Scaly nipple
- Tender breast
Post-mastectomy lymphedema
Common in upper arms due to interruption of lymphatic drainage and removal of nodes
Normal presentation of male breast cancer
retroareolar lump.
When does breast development begin
8-10 years
Breasts in the aging woman
- Pendulous, flattened, and saggy
- More granular on palpation
- Terminal ducts around nipples are more prominent and stringy
- Inframammary ridge more prominent
Breasts in the pregnant woman
- visible blue vascular pattern
- breasts and nipples increase in size
- striae may develop
- nipples darker, more erectile, areola widens
- Montgomery glands elevated
- Breasts more nodular
- Colostrum after first trimester
