W - Breastfeeding

Question 1

Functions of prolactin & oxytocin (1+2)?
Where are they synthesized?

Answer 1

Prolactin
- stimulates production of milk

Oxytocin
- makes smooth muscle cells around the glands in the breasts contract so that they release the milk.
- helps muscle in the uterus contract during labor.

Location:
- both are synthesized in: hypothalamus and pituitary gland.

Question 2

Physical examination - Breast exam

Methods of assessment for the breast exam? (10)

Answer 2

• inspection & palpation!!!

1. inspect bilaterally & in various positions
   - ask client to raise hands above their head, lean forward, and while pushing their hands together.
2. inspect for size, symmetry, shape, and venous patterns.
   - sometimes appear slightly asymmetrical and is normal
   - marked asymmetry is unexpected
3. skin should look smooth, color should be similar to rest of the body’s pigmentation
   - localized redness or warmth could be cellulitis or mastitis -> breast abscess (painful collection of pus)
4. look under the breast, especially for clients who are obese and have very large breasts
   - check for a rash = candidiasis due to accumulation of moisture
5. inspect areolae
   - will vary in color depending on the client’s skin tone
   - can appear round or oval, but should be symmetrical on both breasts
   - normal to see fine hairs & Montgomery glands: small structures that release milk and sebaceous fluid
6. inspect the nipples
   - should be bilaterally symmetrical, but might appear either flat, protruding, or inverted
   - if client has supernumerary nipples = normal
   - can hv pink or brown moles typically along the embryonic “milk line.”
7. palpate along the axillary lymph nodes
   - assess for tenderness or enlargement
   - check for masses or lumps.
   - usually axillary lymph nodes aren’t palpable, but if they are, should be small, nontender, soft, and mobile.
   - Hard, non-mobile lymph nodes can be associated with cancer.
8. assist client to lie supine with one arm above their head
   - palpate each breast while it is flat against the chest wall
   - use pads of your first 2 to 3 fingers to palpate all quadrants of the breast first with light pressure, then medium, and finally deep pressure
   - palpate through the tail of Spence, which stems from the top of the breast towards the axilla.
9. if a lump or nodule is identified:
   - palpate mass for characteristics: location, size, shape, consistency, and mobility.
   - smooth, firm, rubbery, freely movable and nontender lump = fibroadenoma (non cancerous lump
   - nodular and tender lump = fibrocystic breast disease (pain, noncancerous)
   - hard, irregularly shaped, painless lump = breast cancer.
10. palpate nipple.
    - should be soft and elastic without lumps or discharge.

Question 3

Approaches commonly used for breast palpation? (3)

Answer 3

1. circular technique
   - start palpating at the outside of the breast tissue and spiral inwards until you’ve palpated over the nipple.
2. wedge method
   - palpate from middle of breast outwards in radial lines, returning to the nipple to begin each line
3. vertical strip method
   - start palpating at top of breast & move downward and then back upward until you’ve palpated the entire breast.

Question 4

Expected variations in breast tissue? (2)

Answer 4

• soft diffuse bumps associated with the glandular and fatty tissue inside breasts
• common to palpate a firm transverse ridge along the lower edge of the breast

Question 5

assessment findings that can be associated with breast cancer? (6)

Answer 5

1. unilateral rash and a scaly nipple = Paget’s disease
2. roughened, bumpy, thick, orange peel-like skin = inflammatory breast cancer
3. unilateral venous pattern = increase in blood flow around a malignancy
4. dimpling of the breast tissue
5. nipple retraction = flattening or pulling
   inward of the nipple and areola
6. fixation of breast tissue that doesn’t adjust with movement.