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Nursing 209 > Test 3: Breast and Axilla Assessment > Flashcards

Test 3: Breast and Axilla Assessment Flashcards

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1
Q

Redness and warmth indications:

A

Inflammation or infection
Mastitis
Abscess
Inflammatory CA

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2
Q

Risk Factors for Breast CA

A

Age - Older, more likely

Gender - Female more likely

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3
Q

Risk Factors: Personal Family History

A
  • Family member with history of breast CA
  • Ashkenazi Jewish Heritage
  • African American with breast cancer before 35
  • Man in family with breast CA
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4
Q

Risk Factor: Estrogen Exposure

A
  • First period before 13
  • Entering menopause after 51
  • Using estrogen replacement for more than 5 years
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5
Q

Risk Factors: General

A
  • Never been pregnant or pregnancy after 30
  • No breastfeeding
  • Higher education and socioeconomic group
  • Taller height
  • Sitting (more than 6 hours a day)
  • Dense Breasts
  • High waist-hip ratio
  • High fat diet
  • Radiation exposure
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6
Q

Mortality Risk Factors

A
  • Poor screening

* Even though breast CA more common in women, the mortality rate is higher in men

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7
Q

Breast Discomfort

A

Note pattern, onset, duration,severity, character, associated S&S, and contributing and relieving factors

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8
Q

Swelling or lumps

A

Location, size, changes in surface of breast, mobility, time 1st noted, changes in menses, assoc. S&S

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9
Q

Discharge

A

Color, consistency, amount, odor, onset/injuries, date of last pregnancy/birth, breastfeeding history, medication (contraceptives may produce a clear discharge)

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10
Q

Equipment needed for PE

A

Gloves
Small pillow
cm ruler
Glass slide and fixative (for possible discharge)

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11
Q

Skin: Normal

A
  • Pink to dark brown areola/nipple
  • Hyper-pigmentation normal if smooth and symmetrical
  • Even color
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12
Q

Skin: Abnormal

A

Redness
Texture (peau d’orange) - Breast looks like orange peel due to swelling
*Focal areas of dark skin or discoloration

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13
Q

Vascularity: Normal

A
  • Symmetrical, diffuse pattern
  • Not prominent
  • May be easy to see in pregnant or obese women
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14
Q

Vascularity: Abnormal

A
  • Focal, unilateral area of increased venous prominence

* Engorged vessels may indicate feeding a tumor

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15
Q

Moles

A

Common, ask if recent changes or changes in size and color

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16
Q

Striae

A

Stretch marks

Normal

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17
Q

Supernumerary Nipple

A

Accessory nipple

  • Occurs along milk like ( like dogs)
  • Can grow breast tissue, be painful, change in menses
  • Increased risk of breast cancer in this tissue
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18
Q

Breast Size and Symmetry: Normal

A

Approximate in size and basically symmetrical

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19
Q

Breast Size and Symmetry: Abnormal

A

*Grossly different in size

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20
Q

Gynecomastia

A

Large breasts in men or infants

  • can secrete milk
  • hard disc under nipples
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21
Q

Gynecomastia Causes

A
  • Puberty
  • hormone imbalance due to tumor on pituitary, prostate and testes
  • Alcohol abuse
  • Meds (estrogen, depression, steroid abuse)
  • Leukemia
  • Cirrhosis of the Liver
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22
Q

Contour of Breast: Normal

A

Smooth, even, rounded, convex, uninterrupted surface

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23
Q

Contour of Breast: Abnormal

A
  • Retraction (inverted nipple)
  • Dimpling (depression on skin)
  • Flat on one side - breast do not look round
  • Obvious Bulges
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24
Q

Hair: Normal

A

Women may have dark curly hair on areola

Male may have dense mass of chest hair

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25
Q

Hair: Abnormal

A

If women have male hair pattern

26
Q

Nipple Color: Normal

A

Darker than surrounding breast

May darken during pregnancy

27
Q

Nipple Color: Abnormal

A

Reddened or gross asymmetry

28
Q

Nipple Size and Shape: Normal

A

Symmetrical,roung,wrinkled

29
Q

Montgomery Tubercles

A

Small, elevated sebaceous glands on nipple
Secrete protective lipid material during lactation
Normal

30
Q

Nipple Size and Shape: Abnormal

A
  • Inverted,unless if been inverted since puberty

* Nipple different color than areola

31
Q

Paget’s Disease

A
  • CA of mammary gland
  • Crusting, cracking, scaling, discharge, rash, ulceration (esp. unilateral)
  • Shape may be unilateral (gross asymmetry)
32
Q

Direction of Nipples: Normal

A
  • On nipple line
  • Point outward and downward (laterally)
  • Symmetrical
33
Q

Direction of Nipples: Abnormal

A
  • Not on nipple line

* Asymmetrical

34
Q

Discharge: Normal

A
  • No discharge
  • Can have clear discharge with mechanical manipulation
  • Pregnant or lactating women may have a milky discharge
35
Q

Discharge: Abnormal

A
  • Milky, watery, purulent, serous, bloody

* Caused by drugs (estrogen,, anti-HTN, anti-depressants), endocrine disorders, CA, benign breast lesions

36
Q

Inspection Positions

A
  • Raise arms overhead
  • Press hands together
  • Look for changes in appearance, especially retractions, dimpling, or fixation of breasts, and uneven nipple line
  • Press into hips
  • For women with large pendulous breast, also with arms stretched out in front, we want the breasts to hang free and away from the body
37
Q

Lateral (Brachial) Node

A

The node goes up the arm from inside the axilla

Along the humerus, inside the upper arm

38
Q

Central Axillary Node

A

Way deep into the center of the underarm

High up in the middle of the axilla, over the ribs and serratus anterior muscle

39
Q

Subscapular Node

A

Towards the back behind the axillary line. Can feel the muscle mass that goes towards the back
Along the lateral edge of the scapula, deep in the posteror axillary fold

40
Q

Anterior Axillary (Pectoral)

A
  • Located on the muscle that is under the breast

* Along the lateral edge of the pectorals major, just inside the anterior axillary fold

41
Q

Palpation of Breasts

A
  • Palpate the breasts normally in a sitting position
  • If pt. reports a mass, do that breast second so we can have a control with the normal breast
  • If woman has large breasts use the bi-manual technique with dominant hand on top
  • Remember to palpate the Tail of Spence, using the 3 middle fingles (flat part)
  • Palpate the nipple itself and squeeze the nipple in all four directions
42
Q

Palpation Findings

A
  • Most masses and CA occur in the Tail of Spence in the UOQ
  • Normal breast consistency varies (lumpy,granular, non-uniform, nodular)
  • Note any mass or thickening that is different form other tissue or that is a change
43
Q

Location of Breast Mass

A
  • Note which breast, right or left
  • Quadrant
  • Time designation
  • cm from nipple
44
Q

Shape of Breast Mass

A

round, ovoid, irregular, (confluent), multiple lesions together

45
Q

Consistency of Breast Mass

A

soft
hard
rubbery
solid

46
Q

Discreteness of Breast Mass

A

Sharp
well defined borders
irregular
difficult to find borders

47
Q

Mobility

A 
Freely movable (usually benign)
Fixed (bad sign)
48
Q

Depth of mass

A

Superficial
midlevel
deep against ribs

49
Q

Malignant tumor

A

Spread out, irregular shaped
Fixed
Grabbing onto other structures (causing dimplint)

50
Q

Benign abscess

A

Confluent, not fixed, smooth

51
Q

Fibrocystic Disease

A

Very Round lumps
Very cystic (fluid flilled)
Discrete
Can be painful and have changes with menses

52
Q

Intraductal Papilloma

A

Usually cause bleeding in milk duct

Typically not malignant

53
Q

Mastectomy Exam

A

Could still have residual cancer tissue that can cause growth
Want to look at scar itself for dimpling, redness, buldges

54
Q

MRI

A

Magnetic Resonance Imaging

55
Q

PET Scan

A

Positron Emission Tomography

  • Medical imaging that uses radioactive chemical injected into tissue and absorbed by specific kinds of body tissue, such as CA
  • Pts. with breast implants and dense breasts may benefit from PET scans
56
Q

Sentinel Node Biopsy

A
  • A new test being used, uses PET scanning
  • Aims to accurately stage the axillary or other node involvement
  • Technique used to identify the first nodes that tumor drains to
  • Used to see where the cancer has spread to and what stage the cancer is in
57
Q 
Fibrocystic:
Age
Occurrence
Location
Nipple Discharge
Pain or Tenderness
Number
Shape
Consistency
Mobility
Retraction
Borders
Variations w/ menses
A

age:20-49
occurrence: usually bilateral
Location: UOQ
Nipple discharge: no
Pain or tenderness: yes
Number: Multiples or single
Shape:round
Consistency: soft to firm or tense
Mobility: mobile
Retraction: Absent
Borders: well delineated
Variations with menses: yes

58
Q 
Fibroadenoma
Age
Occurrence
Nipple Discharge
Pain or tenderness
Number
Shape
Consistency
Mobility
Retraction
Borders
Variations with menses
A 
Age: 15-55
Occurrence: usually bilateral
Location: no specific
Nipple discharge: no
Pain or tenderness: no
Number: single; sometimes multiple
Shape: rounded or discoid
consistency: firm, rubbery
Mobility: mobile
Retraction: absent
Borders: well delineated
Variations with menses: no
59
Q 
Cancer
Age
Occurrence
Location
Nipple Discharge
Pain or tenderness
Number
Shape
Consistency
Mobility
Retraction
Borders
Variations with menses
A 
Age: 30-80
Occurrence - Usually unilateral
Location: 48% in UOQ but also any part
Nipple discharge: bloody or clear if present
Pain or tenderness: usually no
Number: shape
Shape: irregular or stellate
Consistency: hard, stone-like
Mobility: fixed
Retraction: often present
Borders: poorly delineated; irregular
Variations with menses: no
60
Q

Cooper Ligaments

A

Fibrous connective tissue extending vertically form the skin surface to attach on chest wall muscle. These support the breast tissue

61
Q

Colostrum

A

Thick, yellow fluid that is the precursor to breast milk
Contains no fat
Rich in antibodies to protect the newborn against infection

Nursing 209 (9 decks)

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