Health Assessment and Breast Exam Guidelines
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Questions and Answers

What clinical manifestation is typically observed in advanced stages of breast cancer?

  • Nontender, fixed, hard masses
  • Nipple retraction (correct)
  • Upper outer quadrant predominance
  • Diffuse breast pain

    • Which statement regarding postmenopausal breast cancer is correct?

  • Lymphedema is not a concern after a total mastectomy.
  • Modified radical mastectomy includes axillary lymph node dissection. (correct)
  • Breast conservation treatment is the only surgical option.
  • Metastasis typically affects only the lungs.

    • What is the significance of tumor size in breast cancer prognosis?

  • Smaller tumors usually correlate with higher survival rates. (correct)
  • Larger tumors have better survival rates.
  • Smaller tumors indicate worse prognosis.
  • Tumor size has no impact on prognosis.

    • What is a common complication associated with post-mastectomy care?

    <p>Lymphedema in the affected extremity.</p> Signup and view all the answers

    Which area is commonly affected by metastasis in breast cancer cases?

    <p>Axillary lymph nodes</p> Signup and view all the answers

    What is a key aspect of nursing management post-mastectomy?

    <p>Patient education regarding drain care.</p> Signup and view all the answers

    Which of the following is NOT a typical clinical manifestation of breast cancer?

    <p>Severe pain throughout the body</p> Signup and view all the answers

    In the TNM staging of breast cancer, what does 'M0' signify?

    <p>No distant metastasis</p> Signup and view all the answers

    What is the best time for women of childbearing age to perform a self-breast exam?

    <p>5-7 days after menses</p> Signup and view all the answers

    Which diagnostic tool is primarily used to detect non-palpable lesions?

    <p>Mammography</p> Signup and view all the answers

    What condition is characterized by erythema of the nipple and areola, and is also common in men?

    <p>Paget's Disease</p> Signup and view all the answers

    What is the classic sign of advanced inflammatory breast disorder?

    <p>Peau d'orange</p> Signup and view all the answers

    At what age should women begin getting annual mammograms?

    <p>40</p> Signup and view all the answers

    Which condition is characterized by fluid-filled sacs that occur due to the dilation of breast ducts?

    <p>Cysts</p> Signup and view all the answers

    What type of breast tumor is described as firm, round, and movable?

    <p>Fibroadenoma</p> Signup and view all the answers

    What is the purpose of fine needle aspiration in breast diagnostics?

    <p>To conduct a histopathologic analysis</p> Signup and view all the answers

    Which statement about breast cancer risk factors is NOT true?

    <p>Breastfeeding decreases risk.</p> Signup and view all the answers

    Which hormone-related condition can cause breast pain experienced prior to menstruation?

    <p>Mastalgia</p> Signup and view all the answers

    How often should a clinical breast exam be performed for women in their 20s and 30s?

    <p>Every three years</p> Signup and view all the answers

    What age should women begin screening mammograms based on family history?

    <p>40</p> Signup and view all the answers

    Which medication is used for chemoprevention of breast cancer for pre-menopausal women?

    <p>Tamoxifen</p> Signup and view all the answers

    What is the role of external compression devices in managing lymphedema?

    <p>To promote drainage of lymphatic fluid back into the bloodstream</p> Signup and view all the answers

    Which of the following assessments would indicate the formation of a hematoma?

    <p>Swelling, tightness, pain, and bruising</p> Signup and view all the answers

    What should nursing education focus on regarding self-care after a mastectomy with axillary lymph node dissection?

    <p>Avoiding blood pressure measurements in the affected arm</p> Signup and view all the answers

    What is a common side effect of chemotherapy that requires specific nursing interventions?

    <p>Hair loss and mucositis</p> Signup and view all the answers

    What nursing intervention is appropriate for managing xerostomia during chemotherapy treatment?

    <p>Suggest sucking on zero-sugar hard candy</p> Signup and view all the answers

    What common complication is associated with radiation therapy?

    <p>Erythema and breast edema</p> Signup and view all the answers

    Which of the following is an indication that a seroma may be present?

    <p>Fullness, discomfort, and sloshing fluid</p> Signup and view all the answers

    What is a key nursing management step for the side effects of chemotherapy?

    <p>Rinsing the mouth with normal saline</p> Signup and view all the answers

    What should patients avoid wearing on the radiation treatment area to prevent irritation?

    <p>Tight clothes and underwire bras</p> Signup and view all the answers

    Which action is essential before commencing external beam radiation therapy?

    <p>Mapping out and marking treatment areas</p> Signup and view all the answers

    What is the most common site for distant metastasis in breast cancer?

    <p>Bone</p> Signup and view all the answers

    Which of the following describes a typical characteristic of a suspicious breast mass?

    <p>Nontender, fixed, hard with irregular borders</p> Signup and view all the answers

    What post-operative complication is associated with mastectomy?

    <p>Lymphedema</p> Signup and view all the answers

    Which type of surgical management involves the removal of all breast tissue and axillary lymph nodes?

    <p>Total mastectomy</p> Signup and view all the answers

    What is a significant factor in determining the prognosis of breast cancer?

    <p>Tumor size and lymph node involvement</p> Signup and view all the answers

    Which nursing education topic is crucial for patients post-mastectomy?

    <p>Drain care and management</p> Signup and view all the answers

    Which sign indicates advanced stages of breast cancer?

    <p>Skin dimpling and nipple retraction</p> Signup and view all the answers

    What action should patients avoid after axillary lymph node dissection?

    <p>The use of BP cuffs on the affected arm</p> Signup and view all the answers

    What is a common nursing intervention for managing lymphedema?

    <p>Performing active and passive exercises</p> Signup and view all the answers

    Which symptom indicates the formation of a seroma post-surgery?

    <p>Feelings of fullness and sloshing fluid</p> Signup and view all the answers

    What should patients post-mastectomy avoid until their surgical site heals?

    <p>Using perfumed soap</p> Signup and view all the answers

    What is a significant side effect of chemotherapy that patients may experience?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which of the following should be included in client education regarding drain management post-mastectomy?

    <p>Drains must remain in until cleared by the surgeon</p> Signup and view all the answers

    Which treatment option is most commonly initiated after chemotherapy?

    <p>External beam radiation</p> Signup and view all the answers

    What should patients undergoing radiation therapy do to manage skin irritation?

    <p>Apply Lubriderm or Eucerin for dryness</p> Signup and view all the answers

    What complication should nurses monitor for in patients post-mastectomy indicating potential blood leakage?

    <p>Hematoma formation</p> Signup and view all the answers

    Which intervention is helpful for managing dry mouth during chemotherapy?

    <p>Sipping water frequently and using zero-sugar candies</p> Signup and view all the answers

    What is a potential consequence if a seroma is not drained appropriately?

    <p>Development of an infection</p> Signup and view all the answers

    What is the recommended frequency for clinical breast exams for post-menopausal women?

    <p>Annually</p> Signup and view all the answers

    Which imaging technique is most effective in distinguishing between fluid-filled cysts and other lesions?

    <p>Ultrasonography</p> Signup and view all the answers

    What is the criterion for starting mammogram screenings based on family history?

    <p>10 years younger than relative's diagnosis</p> Signup and view all the answers

    Which benign condition is characterized by a firm, round, and movable tumor?

    <p>Fibroadenoma</p> Signup and view all the answers

    What is a classic clinical sign of Paget's disease in the breast?

    <p>Erythema of the nipple and areola</p> Signup and view all the answers

    What does the term 'peau d'orange' refer to in breast disorders?

    <p>Classic sign of advanced inflammatory breast disorder</p> Signup and view all the answers

    What is a common risk factor for breast cancer related to hormonal factors?

    <p>Early menarche</p> Signup and view all the answers

    Which age group of women is advised to begin annual mammograms?

    <p>45 years and older</p> Signup and view all the answers

    Which type of breast biopsy allows for the removal of a tissue core using a spring-loaded device?

    <p>Core Needle Aspiration</p> Signup and view all the answers

    Which factor is a protective measure against breast cancer in post-menopausal women?

    <p>Raloxifene</p> Signup and view all the answers

    What is the purpose of the histopathologic analysis performed via fine needle aspiration?

    <p>To analyze tissue or fluid for abnormalities</p> Signup and view all the answers

    Which imaging technique involves the use of IV contrast dye?

    <p>MRI</p> Signup and view all the answers

    Which condition is most commonly characterized by tenderness in women aged 30-55?

    <p>Breast pain/mastalgia</p> Signup and view all the answers

    Which of the following is NOT a risk factor for breast cancer?

    <p>Frequent exercise</p> Signup and view all the answers

    Study Notes

    Health Assessment

    • Assess onset of breast disorders and social history, including length of time and medication use.
    • Observe for signs like masses, pain, swelling, redness, skin changes, and nipple discharge.
    • Conduct clinical breast exams every three years for women aged 20-30, and monthly for post-menopausal women.

    Self-Breast Exam Guidelines

    • Optimal time for self-exam is 5-7 days post-menses; report any abnormalities to healthcare provider.
    • Begin annual breast exams and mammograms at age 40; women aged 40-44 may begin earlier if desired.

    Inspection and Palpation

    • Inspect skin for color, venous prominence, thickening, and edema; erythema can indicate malignancy.
    • Edema and sluggish skin texture suggest blockage of venous drainage; evaluate for any ulcerations or discharge.
    • Paget's disease presents with erythematous nipple and areola; common in men.
    • "Peau d’orange" is a classic sign of advanced inflammatory breast disorder.
    • Tail of Spence, an axillary extension of breast tissue, is a common site for tumors and must be examined.

    Mammography

    • Mammography is the gold standard for detecting non-palpable lesions and diagnosing palpable masses, effective for lesions <1 cm.
    • Begin mammography screening at least 10 years before the age at which a relative was diagnosed, or at age 45.
    • Two views of each breast are standard, with exams lasting 15-30 minutes.
    • Young women and those on hormone therapy may pose diagnostic challenges due to breast tissue density.

    Other Diagnostics

    • Ultrasonography helps differentiate between fluid-filled cysts and other lesions; dark appearance denotes cysts.
    • Galactography aids in assessing nipple discharge and solitary dilated ducts.
    • MRI is valuable for multifocal or multicentric tumors, assessing response to treatment.
    • Fine Needle Aspiration (FNA) provides histopathologic analysis using a small gauge needle.
    • Core Needle Aspiration offers more definitive tissue samples via a larger gauge needle.

    Benign Conditions

    • Mastalgia can be cyclical or non-cyclical, often linked to hormonal changes or trauma.
    • Cysts are fluid-filled sacs typically found in women aged 30-55; may cause tenderness.
    • Fibroadenomas are benign, firm, round, movable tumors, common but non-tender.
    • Benign proliferative breast conditions, while non-malignant, elevate breast cancer risks.

    Breast Malignancy

    • Ductal Carcinoma in situ (DCIS) is characterized by malignant proliferation within milk ducts without invasion, recognizable on mammograms by calcifications.
    • Early treatment may involve mastectomy; breast conservation is possible based on individual cases.
    • Key risk factors for breast cancer include early menarche, genetic predispositions (BRCA1/2), obesity, late menopause, and excessive alcohol intake.

    Protective Factors

    • Chemoprevention options like tamoxifen and raloxifene can reduce cancer risk.
    • Regular physical activity, breastfeeding, and full-term pregnancies before age 30 are beneficial.
    • Long-term monitoring through mammograms and MRIs is essential; prophylactic mastectomy can be discussed.

    Clinical Manifestations and Staging

    • Initial signs of breast cancer include fixed, hard lumps with irregular borders, and advanced cases may show skin dimpling or ulceration.
    • Common metastasis locations are the bones and lymph nodes, with distant spread frequently impacting lungs, liver, and brain.
    • TNM staging describes tumor size, lymph node involvement, and metastasis extent.

    Prognosis and Surgical Management

    • Prognosis correlates with tumor size and lymph node spread; smaller tumors have better survival rates.
    • Modified radical mastectomy involves removing breast tissue and lymph nodes, often followed by drain care.
    • Total mastectomy includes removal of the entire breast and surrounding tissues.

    Post-operative Management and Education

    • Essential to educate patients on drain care, signs of complications like lymphedema, hematoma, and the importance of self-care post-surgery.
    • Limit weight-lifting to 5-10 lbs until medically cleared; provide support for emotional adjustment and practical aspects such as driving and self-care abilities.

    Radiation and Chemotherapy

    • External beam radiation is typically administered for six weeks, with side effects such as fatigue and skin irritation.
    • Chemotherapy may be adjuvant and uses agents like cyclophosphamide and taxanes; common side effects include nausea, fatigue, and hair loss.
    • Neutropenia management includes medications like filgrastim to boost white blood cells.

    Reconstruction and Recurrent Cancer Management

    • Reconstruction can improve body image post-mastectomy; discuss options with plastic surgeons.
    • Manage recurrent cancer by assessing prognosis and treatment strategies, including hormonal therapy and palliative care.

    Health Assessment

    • Assess patients' general health and onset of breast disorder.
    • Collect social history and recent testing results.
    • Inquiry into medications and symptoms: masses, pain, swelling, redness, nipple discharge.

    Guidelines for Breast Examination

    • Best time for self-breast exam for women of childbearing age is 5-7 days post-menses.
    • Report abnormalities to healthcare provider promptly.
    • Clinical breast exams recommended every three years for ages 20-30; monthly for post-menopausal women.
    • Annual breast exams and mammograms starting at age 40.

    Inspection and Palpation Techniques

    • Skin inspection should include checking for color changes, venous patterns, thickening, and edema.
    • Erythema may signify benign local inflammation or malignancy.
    • Prominence of veins can indicate increased blood supply due to tumors (angiogenesis).
    • Ulcerations or rashes require further evaluation for malignancy.
    • Classic sign of an inflammatory breast disorder is peau d’orange (skin resembling orange peel).
    • Tail of Spence, area extending into the axilla, must be palpated as it's a common tumor site.

    Mammography

    • Gold standard for detecting non-palpable lesions; effective for masses <1 cm.
    • Begin screening mammograms at age 45; younger if family history is present.
    • Procedure takes 15-30 minutes and requires two views of each breast.
    • Tissue density can make diagnosis challenging in younger women or those on hormones.
    • Involves radiation exposure and may cause mild pain.

    Other Diagnostics

    • Ultrasonography distinguishes fluid-filled cysts from other lesions, appearing dark on imaging.
    • Galactography diagnoses nipple discharge issues through injected radiopaque material.
    • MRI useful for assessing multifocal cancers and response to chemotherapy.
    • Fine Needle Aspiration (FNA) provides a histopathologic analysis via a small gauge needle.
    • Core Needle Aspiration offers a more definitive tissue core biopsy using a larger needle.

    Benign Conditions

    • Mastalgia (breast pain) can be cyclical or non-cyclical, often linked to hormonal changes.
    • Breast cysts are fluid-filled sacs common in women aged 30-55.
    • Fibroadenomas are firm, mobile, benign tumors, typically non-tender.
    • Benign proliferative breast disorder can increase breast cancer risk despite being non-malignant.

    Breast Malignancy Overview

    • Ductal Carcinoma in situ (DCIS) is characterized by malignant cells in ducts without surrounding tissue invasion and appears as calcifications on mammograms.
    • Surgical options may include mastectomy for their treatment.
    • Risk factors include early menarche, family history, obesity, and genetic mutations like BRCA1 and BRCA2.

    Protective Factors

    • Chemoprevention methods such as tamoxifen and raloxifene reduce cancer risk.
    • Regular physical activity, breastfeeding, and early pregnancy may lower risk.
    • Long-term surveillance and prophylactic mastectomy are considered in high-risk individuals.

    Clinical Manifestations of Breast Cancer

    • Tumors often present as hard, fixed masses with irregular borders.
    • Advanced signs include peau d’orange, nipple retraction, and skin ulceration.
    • Common metastasis sites include bones and axillary lymph nodes.

    Staging and Prognosis

    • Staging is determined by tumor size (T0-T4), lymph node involvement (N0-N3), and metastasis (M0-M1).
    • Smaller tumors and lack of lymph node involvement correlate with better prognosis; 5-year survival rates significantly drop with advanced stages.

    Surgical Management

    • Modified radical mastectomy involves the removal of breast tissue and axillary lymph nodes.
    • Total mastectomy encompasses all breast and surrounding tissue.
    • Post-operative care includes monitoring for potential complications like lymphedema and infection.

    Post-operative Education

    • Educate patients on drain care and self-monitoring for complications.
    • Emphasize arm exercise, lifting restrictions, and signs of infection.
    • Swelling, pain, and bruising may indicate hematoma; seromas require drainage.

    Chemotherapy Management

    • Common side effects include nausea/vomiting, bone marrow suppression, and hair loss.
    • Medications like ondansetron and filgrastim support symptom management.
    • Emphasize oral hygiene for mucositis and dietary adjustments.

    Reconstruction

    • Discuss body image, emotional impact, and surgical options for breast reconstruction.
    • Procedures may involve tissue expanders or implants and require comprehensive pre-surgical discussions with patients.

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    Med Surg #2 Breast Disorders PDF

    Description

    This quiz explores key concepts in health assessment related to breast disorders, including clinical examination practices, self-breast exam guidelines, and awareness of symptoms. Participants will learn about the importance of regular screening and recognizing potential signs of breast health issues.

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