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Physical health Assessment
Breasts and Regional Nodes
Lecturer/ Hanaa Eisa
Learning out come
At the end of this Lesson the study participants will
be able to:
1. Describe the anatomy & physiology of the
breasts and regional lymphatics, including age
related variations.
2. Demonstrate assessment techniques for the
evaluation of the breasts and regional lymphatics.
3. Distinguish common variations and
abnormal changes of the breasts.
4. Discuss methods of teaching breast self-
examination to patients.
5. Identify risk factors for breast cancer.
Learning out come cont’d
Anatomy and physiologyof the breast
o Function: o Milk production .
o Tail of Spenceo Cooper’s ligamentso Nippleo Lactiferous ductso Areolao Montgomery’s tubercleso Lobeso Lobules
Anatomy and physiologyof the breast
o Alveoli or acinio Lymphatic drainage
o Axillary nodes: central, pectoral, subscapular, lateral
o Internal mammary chain
Anatomy and physiologyof the breast
Breast development
o Usually begins at 10 to 11 years of ageo Stimulated by estrogen release during puberty
Health history
Patient profileo Ageo Gendero Race
Common chief complaintso Breast mass, tenderness, dischargeo Assess the following characteristics
• Location• Quality• Quantity• Associated manifestations• Aggravating factors• Alleviating factors
Health history
Past health historyo Breast specific vs. Systemico Medicalo Surgicalo Medicationso Allergies
Health history
Family historyo Breast cancero Benign breast disease
Health history
Social historyo Alcohol useo Tobacco useo Work environmento Home environmento Economic statuso Ethnic background
Health history
Health maintenance activitieso Dieto Exerciseo Breast self-examo Mammogram
Health history
Assessment
Equipmento Towelo drapeo centimeter rulero teaching aid for breast self-exam
General approach Inspection Patient positions
Assess the following areaso Breastso Areolar areaso Nippleso Axillae
Assessment
Assess the following characteristics1. Color2. Vascularity3. Thickening/edema4. Size and symmetry5. Contour6. Lesions/masses7. Discharge
Assessment
Palpation
1. Sequential manner
2. Supraclavicular and Infraclavicular nodes
3. Breasts, arms at side, arms raised
4. Axillary nodes
5. Breasts, supine position
Evaluation of breast mass characteristics
1. Location
2. Size
3. Shape
4. Number
5. Consistency
Evaluation of breast mass characteristics
1. Definition
2. Mobility
3. Tenderness
4. Erythema
5. Dimpling or retraction
Normal findings
1. Breast and axillae are flesh colored
2. Areolar areas and nipples are darker in
pigmentation
3. Moles and nevi are normal variants
4. No thickening or edema
1. Minor size variation in the breasts and areolar areas
2. Usually breast on dominant side is larger
3. Nipples should point upward and outward, may point outward and downward
Normal findings
1. Breasts, areolar areas, nipples should be symmetrical
2. Breasts are convex, without flattening, retractions, or dimpling
3. Free from masses, tumors, primary or secondary lesions
Normal findings
1. No discharge from nipples in nonpregnant, nonlactating female
2. Usually, palpable lymph nodes less than 1 cm in diameter are clinically insignificant
3. Palpation should not elicit pain
Normal findings
1. Consistency of breast tissue is highly variable depending upon age, time in menstrual cycle, and proportion of adipose tissue
2. Breasts are usually nodular or granular prior to menses
3. Variation with breast augmentation— breasts feel fluid filled or firm throughout
Normal findings
Risk factors for breast cancer
1. Age > 50 2. Personal history of breast CA3. Mother, grandmother, or sister with breast
CA4. Menarche at an early age5. Menopause at advanced age6. Obesity7. Alcohol intake > 3 servings per day
1. American or European descent2. Urban dweller3. Estrogen therapy4. Nulliparous5. First birth after age 306. Higher education and socioeconomic status7. Atypical hyperplasia
Risk factors for breast cancer
Diagnostic techniques
1. Mammography
2. X- ray
3. Ultrasonography
4. Magnetic resonance imaging
Gerontological variations
1. Breast tissue atrophy
2. Decreased glandular tissue, resulting in granular feeling
3. Breasts become smaller, pendulous, and flatter
4. Ductal tissue becomes more palpable. Stringy feeling
Breast self-examination (BSE)
1. Performed once a month
2. Performed on a fixed date each month, or eight days after menses
3. Avoid completing during menstruation or ovulation
4. Use calendar for monthly reminder
5. Include significant other in examination process
Bed (B): supine position1. Use palmar surface of fingers2. Place right arm over head and palpate
right breast3. Move in concentric circles from the periphery
inward4. Squeeze the nipple to examine for discharge5. Use same procedure to check left breast
Breast self-examination (BSE)
Standing (S)o Repeat previous process in standing position
Examination (E)o Stand before mirror, arms at sideo Assess for symmetry, retractions, dimpling,
inverted nipples, or nipple deviationo Repeat with arms above head, and hands
pressed into hips
Breast self-examination (BSE)
Thank you