Date post: | 31-May-2015 |
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Breast and Axilla
Nursing 330
Governors State University
Shirley Comer
Relevant History
Pain lump Discharge Rash Swelling Trauma Surgery Self exam practices Tenderness
Breast Cancer can occur in men
Inspection
Size and symmetry– One breast may normally be slightly larger than the other
Skin– Smooth, non reddened– No bulges or dimpling– Fine blue veins normal as are striae
Nipple– Position and direction of nipple point– No discharge or retraction– Note lesions in nursing mothers
Screen for Retractions
Retraction is dimpling or puckering Ask pt to bend at the waist Ask to lift arms
– should move symmetrically Ask to put hands on hips
– observe position Ask to press hands together
– should move together
Inspect and Palpate the Axillae
Inspect skin Support patient’s arm Move fingers on a circular position through
axillae– Normally nodes not palpable– Nodes enlarge with local infection and breast cancer
with metastases
Breast Palpation
Patient should be supine (lying down) Place a small towel under shoulder on side to be
assessed Raise pt arm over her head Use pads of 1st three finger to palpate in a rotary
motion Assess entire breast using light, medium and then
deep palpation Cover entire breast- any pattern acceptable
Use the Middle of Your Fingers
Fingertips are too sensitive (all breasts are somewhat lumpy)Palm is too insensitiveMiddle portion of fingers is just right
Palpation cont
Nullaparus breasts feel firm and elastic Post parus breasts feel softer and looser Premenstrual tenderness is common r/t
increased progesterone levels Heat, Redness, and swelling in non lactating
breasts indicate inflammation
Palpate Nipple
Note any indurations or masses Gently squeeze nipple
– note any discharge ie color, consistency, odor
Except in pregnancy and lactation discharge is abnormal
Lactating women often have chaffed or sore nipples
Palpation Technique
Work your way around the breast in a clockwise fashion, using small circles of the hand as you go.Make sure the entire breast is felt.
Tail of Spence
If Lumps found then Assess:
Location Size Shape Consistency Moveable Tenderness Distinctness
Male Breasts
Normal male breasts have flat disk of undeveloped breast tissue beneath nipple
Gynecomastia is enlargement of male breast tissue– Can result from hormone, drug SE or disease
process– May occur normally in adolescence
Temporary Often unilateral
ACS Changes to Recommendationshttp://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp?sitearea=
Clinical Breast Exam– 20’s-30’s = every 3 years– After 40 = every year
Mammography– Every Year Beginning at age 40
MRI yearly for high risk women– BRAC gene– 1st degree relative
Monthly self breast exam= optional
Age Specific Considerations
Infants ‘witch’s Milk” may be secreted in 1st weeks of life– Breasts may be slightly enlarged
Adolescent female breast development occurs between 9 to 13 yo – can be delayed by poor nutrition or hormone
imbalance – lumps are usually benign cysts
Pregnant Female
Breasts and nipples Increase in size Vascularity may become more visible Striae may appear Nipples become darker and more erect Areola widen and contain small scattered
Montgomery’s glands May express thick yell colostrum /p 1st trimester
Lactating Female
Colostrum changes to milk approx 3rd day post partum
Breasts become engorged, reddened and shinny
May feel warm Nipples sore and may crack Frequent nursing is best treatment for
engorged and sore breasts
Aging Breast
May become pendulous an flattened Nipples may retract but should be easily pulled
outward Feels granular with prominent milk ducts Women over 50 have increased risk of breast
cancer Stress Self breast exam
Self Breast Exam
Instruct women to do monthly If premenapausal-do on last day on menstrual
flow If post menopausal or irregular menses-do on
the same day every month Men can also benefit from monthly self exam Report any abnormal findings or changes in
tissue to Doctor
Practice Exam Question
Your sister has fibrocystic disease of the breasts and consequently has many lumps in her breast. She mentions to you that she felt a new hard, unmovable lump this month. What would you advise her to do?
A. disregard it. It is probably another cyst B. check to see if it is bigger next month C. tell her doctor about it at her next yearly pap smear D. Make an appoint to see her doctor ASAP
Rationale
D is the correct answer. A malignant mass is frequently hard and unmovable. Early detection increases her treatment options.