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?

Lymphedema in the affected extremity. Signup and view all the answers

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

Axillary lymph nodes Signup and view all the answers

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

Patient education regarding drain care. Signup and view all the answers

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

Severe pain throughout the body Signup and view all the answers

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

No distant metastasis Signup and view all the answers

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

5-7 days after menses Signup and view all the answers

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

Mammography Signup and view all the answers

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

Paget's Disease Signup and view all the answers

What is the classic sign of advanced inflammatory breast disorder?

Peau d'orange Signup and view all the answers

At what age should women begin getting annual mammograms?

40 Signup and view all the answers

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

Cysts Signup and view all the answers

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

Fibroadenoma Signup and view all the answers

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

To conduct a histopathologic analysis Signup and view all the answers

Which statement about breast cancer risk factors is NOT true?

Breastfeeding decreases risk. Signup and view all the answers

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

Mastalgia Signup and view all the answers

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

Every three years Signup and view all the answers

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

40 Signup and view all the answers

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

Tamoxifen Signup and view all the answers

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

To promote drainage of lymphatic fluid back into the bloodstream Signup and view all the answers

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

Swelling, tightness, pain, and bruising Signup and view all the answers

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

Avoiding blood pressure measurements in the affected arm Signup and view all the answers

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

Hair loss and mucositis Signup and view all the answers

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

Suggest sucking on zero-sugar hard candy Signup and view all the answers

What common complication is associated with radiation therapy?

Erythema and breast edema Signup and view all the answers

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

Fullness, discomfort, and sloshing fluid Signup and view all the answers

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

Rinsing the mouth with normal saline Signup and view all the answers

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

Tight clothes and underwire bras Signup and view all the answers

Which action is essential before commencing external beam radiation therapy?

Mapping out and marking treatment areas Signup and view all the answers

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

Bone Signup and view all the answers

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

Nontender, fixed, hard with irregular borders Signup and view all the answers

What post-operative complication is associated with mastectomy?

Lymphedema Signup and view all the answers

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

Total mastectomy Signup and view all the answers

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

Tumor size and lymph node involvement Signup and view all the answers

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

Drain care and management Signup and view all the answers

Which sign indicates advanced stages of breast cancer?

Skin dimpling and nipple retraction Signup and view all the answers

What action should patients avoid after axillary lymph node dissection?

The use of BP cuffs on the affected arm Signup and view all the answers

What is a common nursing intervention for managing lymphedema?

Performing active and passive exercises Signup and view all the answers

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

Feelings of fullness and sloshing fluid Signup and view all the answers

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

Using perfumed soap Signup and view all the answers

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

Nausea and vomiting Signup and view all the answers

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

Drains must remain in until cleared by the surgeon Signup and view all the answers

Which treatment option is most commonly initiated after chemotherapy?

External beam radiation Signup and view all the answers

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

Apply Lubriderm or Eucerin for dryness Signup and view all the answers

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

Hematoma formation Signup and view all the answers

Which intervention is helpful for managing dry mouth during chemotherapy?

Sipping water frequently and using zero-sugar candies Signup and view all the answers

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

Development of an infection Signup and view all the answers

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

Annually Signup and view all the answers

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

Ultrasonography Signup and view all the answers

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

10 years younger than relative's diagnosis Signup and view all the answers

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

Fibroadenoma Signup and view all the answers

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

Erythema of the nipple and areola Signup and view all the answers

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

Classic sign of advanced inflammatory breast disorder Signup and view all the answers

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

Early menarche Signup and view all the answers

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

45 years and older Signup and view all the answers

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

Core Needle Aspiration Signup and view all the answers

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

Raloxifene Signup and view all the answers

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

To analyze tissue or fluid for abnormalities Signup and view all the answers

Which imaging technique involves the use of IV contrast dye?

MRI Signup and view all the answers

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

Breast pain/mastalgia Signup and view all the answers

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

Frequent exercise 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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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.