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ASSESSING THE BREASTS
NUR211Kathleen Hancock
Assessing the Breasts Obtain a breast history. Perform a breast physical assessment. Document breast assessment findings.Differentiate between normal and abnormal findings.
Breast Composition3 types of tissue:
*Glandular
*Fibrous
*Adipose
Structures Lobes and lobules Lactiferous ducts and sinuses Areola Montgomerys glands
Structures Nipple Coopers ligament Pectoralis major and serratus anterior muscles
FunctionsWhat are the functions ofLobes & lobules: Contain alveoli cells that produce milkLactiferous ducts & sinuses: Carry and store milkAreola: Dark tissue surrounding nipple
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FunctionsWhat are the functions ofMontgomerys glands: Sebaceous glandNipple: Nursing and sexual stimulationCoopers Ligament: Ligament attached to chest wall muscles that supports breasts(Continued)
FunctionsWhat are the functions ofPectoralis major & serratus anterior muscles: Breast overlies these musclesLymph nodes: Drain breast, chest, and arms
Breast Health: Cancer Prevention
Self Breast Exam (SBE)Every monthMammogram After age 40 every yearMore frequent if personal or family historyBreast Exam by nurse or doctor every year
DevelopmentalVariationsWhat developmental breast variations might be seen with:ChildrenPregnant clientsOlder adults
HistoryWhat can the history tell you about the breast?
Biographical dataCurrent health statusPast health historyFamily historyReview of systemsPsychosocial history
SymptomsWhat symptoms signal a problem with the breasts?
Breast lump or mass Pain or tenderness Nipple discharge
Physical AssessmentAnatomical landmarks: quadrants of the breast, include Tail of Spence
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InspectionBreasts: size, shape, symmetry, color, lesions, venous pattern, dimpling, or retractionNipple and areola: nipple position and direction; dischargeAxillae: color, lesions, rashes
Physical Exam - Inspection
Position: sitting, hands on hips, hands over head, leaning forwardTools: small pillow or towel, ruler, gloves, slide, and culture slide.
Sitting, arms at sides
Arms overhead
Arms pressing on hips
Leaning forward
PalpationLymph nodes: axillary, clavicular while sittingBreasts: consistency, masses, tenderness in supine positionNipple: elasticity, masses, tenderness, discharge
Supraclavicular Nodes
Infraclavicular Nodes
Axillary Nodes
Palpation Vertical Strip Method Preferred Approach: supine with pillow or towel under shoulder Pattern (vertical, wedge, or circular) light, medium, and deep
Supine with shoulder support Use pads of fingers of dominant hand
Strip Method of PalpationCover all of breastUse 3 middle finger pads, not tipsUse sliding motionOverlapping dime size circles3 pressure levels: light, medium, deepInclude nipple and areola
Large BreastsBimanual palpation to adequately examine all areasOften have an inframammary ridge
Male BreastInspectionPalpationLymph nodes while sittingBreast while sitting or if large while lying down
Male Breast Enlargement:Gynecomastia
Characteristics of MassesNote:
Location Shape/Borders Size Tenderness Mobility Consistency Temperature Redness
Example: Pertinent Physical Findings Right breast larger than left No dimpling, retraction Small, pea size (0.5cm), movable, rubbery, smooth-edged lesion in right breast at 2 oclock in RUQ No palpable nodes