Health Assessment

  1. Know the lymphatic system of the breasts.
    Know drainage patterns.
    Image Upload 1
  2. What portion of the chest wall do the breasts cover?
    2nd - 6th rib, mid sternal - axillary line.
  3. Know internal structures and functions of the breast.
    • Internal Anatomy
    • Glandular tissue
    • Lobes, lobules, alveoli (produce milk)
    • Lactiferous ducts and sinuses: Can get plugged during breastfeeding and will become very uncomfortable. Is best to self treat early to avoid surgical intervention later.
    • Fibrous tissue: Cancers can atatch to muscles/ligaments. Will not be mobilem --> dimpling/puckering of surrounding skin.
    • Suspensory ligaments, or Cooper’s ligaments
    • Adipose tissue
  4. At what age during development is gynecomastia most common?
    • At adolescence due to temporarily increased estrogen levels. Should normalize after adolescence.
    • Can also occur due to excessive pot smoking ~2yrs or more.
  5. In what quad are most breast cancers found?
    UOQ (Upper, outer quadrant)
  6. What is the Tail of Spense?
    The triangular portion of breast tissue that attaches to the axilla superior/lateral to the UOQ.
  7. What is a supernumerary nipple?
    Extra nipples. Will follow midclavicular line all the way down thorax/abdomen.
  8. Can men get breast cancer?
    Yes. Ratio is 100:1 women:men who will get breast cancer.
  9. Subjective health history questions...
    • Breast
    • 1. Pain
    • 2. Lump
    • 3. Discharge (galactorrhea)
    • 4. Rash (Paget's?)
    • 5. Swelling
    • 6. Trauma
    • 7. History of breast disease
    • 8. Surgery
    • 9. Self-care behaviors

    • Perform breast self-examination?
    • Last mammogram?

    • Axilla
    • 1. Tenderness, lump, or swelling
    • 2. Rash
  10. Objective Data for Breast Exams
    • Preparation, Position, Draping: One breast at a time, one exposed at a time.
    • Equipment Needed
    • Small pillow
    • Ruler marked in centimeters
    • Pamphlet or teaching aid for BSE. Use the shower card as a book mark.
  11. What is galactorrhea?
    • Discharge from "the milky way." (nipple)
    • Unilateral discharge is more cause for concern than bilateral.
  12. What is Paget's?
    • Unilateral crusty rash on the nipple area.
    • Think cancer.
  13. Breast inspection...
    • General Appearance
    • Skin: Puckering/dimpling?
    • Lymphatic Drainage areas
    • Nipple: Paget's? Nipples can also be inverted/everted. An inverted nipple is ok so long as it hasn't recently changed. Can be sucked out in prep for breastfeeding. An everted nipple that has recently switched ot inverted can be a sign of cancer.
  14. What are retraction maneuvers?
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    • Way to find dimpling/puckering in breast tissue because it tenses muscles behind the breasts.
    • Done in front of mirror
  15. How do you inspect and palpate the axillae?
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    • Support pt's arm to keep axilla relaxed. Will not be able to palpate much if trying to do so through contracted muscle.
  16. Objectifying breasts. (The data, that is...)
    • The Breasts - Palpate
    • Position: Lying down is best
    • Technique of palpation: Use pads of fingers.
    • Expected breast tissue findings among various age groups
    • Nipple
    • Bimanual palpation: May need to use both hansd for larger breasts.
  17. How do you record an unusual finding?
    If any lump present, note:

    • 1. Location
    • 2. Size
    • 3. Shape
    • 4. Consistency: Spongy vs. firm?
    • 5. Mobility
    • 6. Distinctness: Does it have a defined shape? If so, probably nonpathogenic.
    • 7. Nipple retraction
    • 8. Overlying skin
    • 9. Tenderness: Better if tender because cancer will not produce pain.
    • 10. Lymphadenopathy: If found, palpate lymph node. Could be cancer, could be infected cyst.
  18. Breast Exam Palpation Patterns
    • Image Upload 5
    • Repetition is the key. Find one that works for you and stick with it.
    • Notice how all include tail of Spense.
  19. How to Teach a Self-Breast Exam...
    • Schedule of self-exam: Soon after period or “birthday” date. 3rd to 5th day after start of mences is best because that is the period of least hormone in the body. If no longer menstrating, just pick a day of the month and stick with it each month.
    • Describe correct technique:
    • Supine or standing
    • One arm behind head
    • Fingerpads of 3 middle fingers
    • Up-and-down or strip pattern
    • Check in front of mirror

    Return demonstration: Ask pt to demonstrate or verbally describe what has just been said to ensure understanding. Good idea with all pt teaching.
  20. What is this?!
    Image Upload 6
    • Benign Breast Disease (AKA Fibrocystic Breast)
    • Is benign, but will be sensitive to hormones and caffeine
  21. What is this?!
    Image Upload 7
    • Breast Cancer
    • Amorphous shape, attached to muscle/connective tissue of breast call.
  22. What is this?!
    Image Upload 8
    • Fibroadenoma
    • Most common in teens-30s
    • Should have well definied shape.
    • Always benign.
  23. What is this?!
    Image Upload 9
    • Plugged Duct
    • Will lead to Mastitis if not treated.
    • Treat by massaging area and have baby feed on this breast 1st.
  24. What is this?!
    Image Upload 10
    • Mastitis
    • Can continue to breast feed
    • Treat by Cat B antibiotics
    • If not treated ---> Breast Abscess
  25. What is this?!
    Image Upload 11
    • Breast Abscess
    • Can use breast pump, but must discard milk because necessary antibiotics will pass into milk.
    • At this point abscess must be surgically drained.
  26. Devlopmental Competence: Aging Women
    • On inspection, breasts look pendulous, flat, and sagging
    • Nipples may be retracted but can be pulled outward
    • On palpation, breasts feel more granular; terminal ducts around nipple feel more prominent and stringy
    • Thickening of inframammary ridge at lower breast is normal, and feels more prominent with age
    • Reinforce value of BSE because...
    • Women over 50 years old have increased risk of breast cancer
    • Older women may have problems with arthritis, limited range of motion, or decreased vision that may inhibit self-care
    • Suggest aids to self-examination; for example, talcum powder helps fingers glide over skin
  27. The male breasts
    Image Upload 12

    (Try not to go blind.)
Card Set
Health Assessment
Chapter 17