WEEK 6- BREASTS Flashcards
Explain how to inspect & palpate breasts & axillae & regional lymphatics.
Wash hands
Introduce self
Explain the procedure
Draping
Sitting upright & then, move to supine
INSPECT:
General appearance
Skin
Lymphatic drainage
Nipple
PALPATION OF BREAST:
supine
arm over head- pillow under arm
three finger gentle rotary movement
palpation patterns
vertical, circles
tail of spence and nipple
AXILLAE- check for rashes
palpate- central axillary nodes
Identify critical findings that may be found.
Critical Findings
Discharge, bleeding, ulcerating diagnosed with cancer
lesion
Mass in a client previously
Identify abnormal findings & the characteristics associated with these findings- retraction, dimpling, discharge, increased temperature of skin & erythema, & gynecomastia.
retraction: indention in breast
dimpling- small depressions/indentions in breast
discharge- presense of fluid
inflmmation of breast- increased temperature of skin- erythema- infection
gynecomastia- breast mass is larger in males- breast promience
Determine when to teach breast self-examination & the proper techniques to your client.
Maneuvers to screen for retraction- with no clothes on
Lift arms over head
Push hands on hips
Push palms together
Lean forward while you support forearms
Identify equipment needed for physical examination & safe infection prevention & control practices.
breast/mammary gland
Female breast
Accessory reproductive organ
Landmarks - quadrants
Tail of Spence
Surface anatomy
Nipple
Milk duct openings
Areola
Sebaceous glands
internal anatomy of breast
(1) Glandular tissue
Lobes, lobules, & alveoli
Lactiferous ducts & sinuses
Store milk
(2) Fibrous tissue
Cooper’s ligaments
(3) Adipose tissue
lymphatics
Landmarks
Axillary nodes
(1) Lateral
(2) Central
(3) Subscapular (posterior axillary)
(4) Pectoral
developmental considerations
Adolescent
Beginning of breast development is prior to menarche
One breast may grow faster than the other
There may be associated tenderness during this stage
Full development may take up to 3 years
Nodularity increases from midcycle to menstruation
pregnant female
Breast changes during 2nd month
Stimulation of expansion of ductal system/supporting fatty tissue and true secretory aleoli
Enlarge/more nodular
Areolae changes
Colostrum
Milk production
developmental- elderly
Decrease in estrogen and progesterone
Atrophy of tissue
Decrease in elasticity and size
breast cancer risk factors
- genetic
- first child after 30
- alcohol
- hormonal contraceptives
cultural/social considerations
Need to be culturally sensitive
Life-time risk for being diagnosed with breast cancer is 1:9
Women who have a first degree relative who had Breast cancer have a 1:7 (Wilkinson, 2007 in Jarvis, 2008)
Incidence is based on socioeconomic level, ethnocultural background, rural locations and inequities in access
health history questions
Pain
Lump
Discharge
Rash
Swelling
Trauma
History of breast disease
Surgery
Self-care behaviors
Last mammogram
promoting health
screening
education
early detection- gail model, pedicree assessment tool
50-74 (mammary screening after 2/3 years)
