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Questions and Answers
What condition is characterized by hard, fixed lymph nodes that may indicate cancer?
What condition is characterized by hard, fixed lymph nodes that may indicate cancer?
Which of the following is a common sign of breast abnormalities that warrants further investigation?
Which of the following is a common sign of breast abnormalities that warrants further investigation?
In which area of the breast is cancer often detected more frequently?
In which area of the breast is cancer often detected more frequently?
What is a potential symptom of a clogged milk duct?
What is a potential symptom of a clogged milk duct?
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What lifestyle factor may increase the risk of breast cancer?
What lifestyle factor may increase the risk of breast cancer?
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When is it recommended to perform a breast exam?
When is it recommended to perform a breast exam?
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What might spontaneous unilateral blood discharge indicate?
What might spontaneous unilateral blood discharge indicate?
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Which factor is NOT associated with an increased risk of breast cancer?
Which factor is NOT associated with an increased risk of breast cancer?
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What is mastalgia commonly referred to as?
What is mastalgia commonly referred to as?
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Which sign can indicate breast abnormalities related to inflammation or infection?
Which sign can indicate breast abnormalities related to inflammation or infection?
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What should women monitor alongside breast health to detect abnormalities effectively?
What should women monitor alongside breast health to detect abnormalities effectively?
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What is one factor that correlates with an increased risk of developing breast cancer?
What is one factor that correlates with an increased risk of developing breast cancer?
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Which of the following symptoms could suggest underlying cancer when identified?
Which of the following symptoms could suggest underlying cancer when identified?
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In which scenario is spontaneous unilateral blood discharge more concerning?
In which scenario is spontaneous unilateral blood discharge more concerning?
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Which quadrant of the breast is known for higher detection rates of abnormal conditions?
Which quadrant of the breast is known for higher detection rates of abnormal conditions?
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What lifestyle change could potentially decrease the risk of breast cancer?
What lifestyle change could potentially decrease the risk of breast cancer?
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Identifying which of the following changes is crucial for early detection of breast cancer?
Identifying which of the following changes is crucial for early detection of breast cancer?
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Which symptom relates to a clogged milk duct in lactating individuals?
Which symptom relates to a clogged milk duct in lactating individuals?
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Study Notes
Chapter 20: Assessing Breasts and Lymphatic System
- This chapter covers assessing breast and lymphatic systems.
- Learning objectives include identifying significant breast anatomy, breast glandular tissue composition, how Cooper's ligaments change with cancer, documenting clinical findings, breast lymphatic system anatomy, and adolescent/pregnant breast development.
- Learning outcomes also include breast self-examination procedure and health promotion concepts.
Breast and Lymphatic System Function
- Function: Produce and store milk nourishing newborns.
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Structure:
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Paired mammary glands:
- External anatomy: Nipple for milk passage, areola and Montgomery glands for lactation.
- Internal anatomy: Glandular tissue, fibrous tissue, fatty tissue.
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Paired mammary glands:
Anatomy of the Breast
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Diagram of breast anatomy shows locations of:
- Cooper's ligaments
- Lactiferous ducts
- Lactiferous sinuses
- Montgomery glands
- Areola
- Nipple
- Lobules
- Lobes
- Adipose tissue
- Pectoralis Major muscle
- Axillary tail of Spence
Embryonic Development
- During embryonic development, a milk line extends from the axilla to the groin.
- Breast development occurs along this ridge.
- If the milk line tissue doesn't atrophy, supernumerary nipples may be present.
Axilla: Tail of Spence
- The axillary area is divided into four quadrants.
- The upper outer quadrant extends into the axillary area and called the Tail of Spence.
- Most breast tumors occur in the upper outer quadrant.
Lymphatics
- Breast has an extensive lymphatic drainage.
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Major axillary lymph nodes:
- Anterior (pectoral): drains anterior chest and breast.
- Posterior (subscapular): drains posterior chest and breast.
- Lateral: drains arms.
- Central: receives drainage from all other nodes.
Male Breast
- Rudimentary structure (thin disc of undeveloped tissue) under the nipple.
- Male breast exams are abbreviated, but an exam of the anterior thorax, chest wall, nipple, and axillary lymph nodes is required.
Gynecomastia
- Enlargement of breast tissue in males, usually temporary during puberty.
- Can significantly impact self-esteem.
- Can recur with aging and possibly due to testosterone deficiency.
Breast: Subjective Data
- Biographical data, chief complaint (followed by HPI - history of present illness)
- Past history (trauma/injury, lumps/mass)
- Family history (breast disease)
- Functional assessment- lifestyle and health practices.
- Relevant details (breast exam/mammogram, diet, exercise, smoking, alcohol use)
Objective Data- Preparing the Client
- Purpose of examination- identify signs of abnormalities.
- Provide privacy and explanation before examination.
- Positioning: sitting then supine.
Objective Data- Equipment
- Centimeter ruler
- Small pillow
- Gloves
Objective Data- Physical Assessment
- Warm hands, Inspection and palpation.
- Consider males' anatomy during assessment.
Inspection: Breast-Normal Findings
- Normal size variability
- Normal shape (round and pendulous)
- Mild asymmetry
Inspection: Breast-Abnormal Findings
- Sudden increase in size of one breast
- Hyperpigmentation
- Erythema (redness) - inflammation(potential infection)
- Unilateral/one-sided dilated veins
- Edema (swelling) - could indicate cancer
Inspection: Breast-Lymphatic Drainage Areas-Normal Findings
- No bulging
- No discoloration
- No edema
Inspection: Breast-Lymphatic Drainage Areas-Abnormal Findings
- Bulging
- Discoloration
- Edema
Inspection: Breast-Nipples-Normal Findings
- Symmetrically sized
- Normally located
- Everted (straight up position) or slightly inverted.
Inspection: Breast-Nipples-Abnormal Findings
- Deviation in pointing
- Nipple retraction
- Discharge (bleeding)
Inspection: Breast-Supernumerary Nipples
- Not common
- Additional nipples may be detected.
Inspection: Breast - Retraction and Dimpling
- Normal finding: Breasts rise when arms are raised.
- Abnormal finding: Dimpling, retraction
Inspection: Breast - Forward Movement of Breasts
- Normal finding: Symmetrical free-forward movement of breasts during exams.
- Abnormal finding: Restricted movement (could indicate cancer)
- Client's arms are supported while she leans forward.
Inspection and Palpation: Axillae
- Normal finding: No rash/infection, less than 1 cm nodes that are discrete, movable, and nontender.
- Abnormal finding: Rash, infection, inflammation, abnormal lymph node findings, hard/fixed lymph nodes (could indicate cancer)
- Lymph nodes are palpated for rashes, infection, or abnormalities in the axilla.
Breast Palpation
- Positioning: supine with a pillow under the examination side.
- Arm overhead
- Palpation using different touch strengths (light, medium, deep)-vertical and rotary motion.
- Palpating entire breast, including the tail of Spence.
Palpation: Breast-Texture & Elasticity
- Normal finding: Firm, smooth, elastic tissue.
- Abnormal finding: Erythema, heat, and swelling. Tissue thickening, suggestive of a malignant tumor.
Palpation: Breast - Tenderness
- Normal finding: Possible tenderness associated with menstrual cycles, varying intensity and location.
- Abnormal finding: persistent, excessive tenderness.
Palpation: Breast-Masses
- Normal findings: No masses.
- Abnormal findings: Masses, specifically hard, immobile, and fixed. Location, size, shape, consistency, mobility, distinctness, skin over the lump, and tenderness assessed for characteristics.
Abnormal Breast Masses
- Fibroadenomas: Benign masses (1-5cm, solid, firm, rubbery, elastic, nontender, round or oval shape, clear margins, mobile).
- Fibrocystic breast disease: Benign multiple tender lumps, nodularity, dominant lumps, nipple discharge, and other symptoms that reflect infections and inflammation (could be a secondary infection to a disorder).
- Breast abscess: complication of infection. (pus pocket that feels hard, looks erythematous, with tenderness and heat).
- Intraductal papilloma: benign tumors in ducts. (palpable nodule underlying the affected duct and potential for serous to serosanguineous discharge).
Palpation: Nipples- Normal Findings
- Physiologic (benign) discharge, usually bilateral, (white, milky and present during pregnancy, breastfeeding, within 1 year of weaning.)
Palpation: Nipples- Abnormal Findings
- Pathologic discharge (Spontaneous, unilateral, and blood).
Examining a Woman with a Healed Mastectomy
- Inspection and palpation of the intact breast and mastectomy area, incisional site, and axilla.
- Observe for erythema, swelling, and skin lesions.
The Male Breast Palpation
- Inspection of the chest wall to note presence of any lumps or swellings.
- Checking the nipple area for similar abnormalities, along with tissue enlargement
- Axillary lymph nodes are assessed.
Breast Self-Exam
- Positioning: Lie down, sit up, mirror review.
- Technique: Circular motions, different pressure levels, up-and-down patterns, hands on hips/shoulders.
- Timing: post-menstrual cycle.
Expected Changes in Aging Female Breasts
- Breasts may appear pendulous (sagging), and flattened (slight downward shift).
- Nipples may be retracted.
- Breasts may feel granular on palpation.
- Decreased firmness.
American Cancer Society Recommendations for Early Detection
- Ages 40-44: Women should have the option to start screening with mammograms yearly.
- Ages 45-54: Women should get mammograms yearly.
- Age 55+: Women can switch to mammograms every other year or continue yearly if in good health and expected to live 10+ years.
Breast Cancer Risk Factors
- Non-modifiable: Gender, age, genetics (BRCA1/2), family/personal history of breast cancer, high breast density/consistency, early menstruation/late menopause, previous chest radiation.
- Modifiable: Hormone replacement therapy, never been pregnant, alcohol consumption, excessive night shift work, excessive weight gain, recent use of oral contraceptives, no breast-feeding history.
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Description
This quiz focuses on Chapter 20, which covers the assessment of the breast and lymphatic systems. It includes key learning objectives related to breast anatomy, self-examination procedures, and the development of breasts in different life stages. Test your knowledge on the crucial aspects of breast health and anatomy.
