Health Assessment: Breast Health Evaluation

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Questions and Answers

What is typically advised for patients post breast surgery?

High-impact activities are encouraged

Steristrips should be removed immediately

Pain relief with strong opioids

Patients should be kept NPO (correct)

Which benign breast condition is characterized by fluid-filled sacs?

Ductal Carcinoma

Fibroadenoma

Cysts (correct)

Mastalgia

What is a known risk factor for breast cancer?

Low-fat diet

Obesity (correct)

Regular exercise

Early menopause

What medication is commonly used for chemoprevention in pre-menopausal women?

Tamoxifen Signup and view all the answers

Which condition is NOT a type of invasive breast carcinoma?

Ductal Carcinoma in situ Signup and view all the answers

Which hormonal factor is NOT listed as a risk factor for breast cancer?

Low estrogen levels Signup and view all the answers

Which of the following describes fibroadenomas?

Nontender and movable Signup and view all the answers

What is a characteristic finding of Ductal Carcinoma in situ (DCIS) on a mammogram?

Microcalcifications Signup and view all the answers

Which characteristic is NOT associated with the clinical manifestations of breast cancer?

Soft, movable lump in the breast Signup and view all the answers

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

Axillary lymph nodes Signup and view all the answers

Which of the following surgical procedures involves the removal of the entire breast, lymph nodes, and surrounding tissues?

Total Mastectomy Signup and view all the answers

What is a significant post-operative complication associated with mastectomy?

Lymphedema Signup and view all the answers

Which option should be avoided in the arm affected by surgery?

Blood pressure measurements Signup and view all the answers

When assessing the prognosis of breast cancer, which factor is most critical?

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

What should nurses educate patients to do with the drainage device post-operation?

Demonstrate how to empty and measure fluid Signup and view all the answers

Which statement about the staging of breast cancer is correct?

N1 indicates lymph node involvement Signup and view all the answers

What is a common complication following surgery that involves blood leaking into surrounding tissues?

Hematoma Signup and view all the answers

Which of the following methods can assist in moving lymphatic fluid into the bloodstream for patients experiencing lymphedema?

Active and passive exercises Signup and view all the answers

Which type of radiation therapy is most commonly administered to patients and typically occurs for 6 weeks?

External beam radiation Signup and view all the answers

What is an appropriate nursing intervention for treating xerostomia in chemotherapy patients?

Use zero-sugar hard candy and sips of water Signup and view all the answers

What should a patient avoid doing with the affected arm after a mastectomy with axillary lymph node dissection?

Lifting heavy objects Signup and view all the answers

Which of the following medications is primarily used to boost red blood cell count in patients undergoing treatment?

Epoetin alfa (Epogen) Signup and view all the answers

What post-operative care step is recommended to prevent infection in the surgical site?

Using IV antibiotics if necessary Signup and view all the answers

Which of the following symptoms should a patient report as a potential problem following surgery?

Increased pain and tightness Signup and view all the answers

Which of the following is a common side effect of chemotherapy treatment?

Bone marrow suppression Signup and view all the answers

In the context of cancer recurrence, which treatment options can be used to control the spread of the disease?

Hormonal therapy, chemotherapy, and targeted therapy Signup and view all the answers

What is the recommended best time for a self breast exam for women of childbearing age?

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

How often should women in their 20s and 30s undergo a clinical breast exam?

Every three years Signup and view all the answers

What is indicated by peau d'orange in breast assessment?

Advanced inflammatory breast disorder Signup and view all the answers

What age should women begin getting mammograms according to the guidelines?

45 years old Signup and view all the answers

What is a characteristic feature of fluid-filled cysts on ultrasonography?

They appear dark on imaging Signup and view all the answers

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

To perform a histopathologic analysis Signup and view all the answers

What does galactography primarily diagnose?

Nipple discharge issues Signup and view all the answers

When should women begin screening for mammography if they have a family history of breast cancer?

10 years younger than the age at which their relative was diagnosed Signup and view all the answers

What can skin changes like ulcerations or spontaneous nipple discharge indicate?

Malignancy and requires further evaluation Signup and view all the answers

What is gynecomastia?

Firm enlargement of glandular tissues in males Signup and view all the answers

What is the primary treatment approach for Ductal Carcinoma in situ (DCIS) if detected early?

Total or simple mastectomy Signup and view all the answers

Which of the following increases a woman's risk of developing breast cancer?

Female gender Signup and view all the answers

What is a significant characteristic of fibroadenomas?

They are movable and firm Signup and view all the answers

Which medication is recommended for chemoprevention in postmenopausal women?

Raloxifene Signup and view all the answers

What is a common finding in benign proliferative breast disorders?

Atypical hyperplasia Signup and view all the answers

What is a common characteristic of breast cancer in its advanced stages?

Irregular borders without tenderness Signup and view all the answers

What type of breast cyst is commonly seen in women aged 30-55?

Fluid-filled cysts Signup and view all the answers

Which factor significantly influences the prognosis of breast cancer?

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

What is the primary objective of a Modified Radical Mastectomy?

To remove the entire breast and surrounding tissues Signup and view all the answers

Which life factor is associated with protective effects against breast cancer?

Frequent childbirth before age 35 Signup and view all the answers

What is a recommended post-operative education point for managing drains after surgery?

Empty and measure fluid before any physical activity Signup and view all the answers

Which of the following is a risk factor associated with breast cancer because of genetic factors?

BRCA1 and BRCA2 mutations Signup and view all the answers

Which of the following best describes peau d'orange observed in breast assessment?

Skin dimpling resembling an orange peel Signup and view all the answers

What should be avoided in the arm affected by surgery after a mastectomy?

Lifting heavy objects Signup and view all the answers

In which part of the breast is breast cancer most commonly found?

Upper outer quadrant Signup and view all the answers

What is a potential complication after a mastectomy that needs careful monitoring?

Lymphedema in the affected extremity Signup and view all the answers

What does a clinical breast exam and mammogram screening recommend for women starting at age 40?

Yearly clinical breast exams and annual mammograms Signup and view all the answers

Which examination technique involves the patient sitting and disrobed to the waist with arms raised overhead?

Inspection of skin color and profile Signup and view all the answers

What is the primary role of ultrasonography in breast diagnostics?

To distinguish between fluid-filled cysts and solid lesions Signup and view all the answers

Why is the tail of Spence important during a breast examination?

It is a common area for tumor development Signup and view all the answers

What is indicated by the presence of erythema in the nipple and areola during a breast exam?

Paget's disease or skin infection Signup and view all the answers

Which sign is classically associated with an advanced inflammatory breast disorder?

Peau d'orange Signup and view all the answers

What should be monitored closely if there are skin changes or spontaneous nipple discharge?

Possibility of malignancy Signup and view all the answers

At what age should women with a family history of breast cancer start mammogram screenings?

10 years younger than when their relative was diagnosed Signup and view all the answers

What is the significance of the special guideline regarding mammography screening?

Start screening when they are 10 years younger than the relative's diagnosis age Signup and view all the answers

What kind of imaging is typically used in conjunction with mammography to assist diagnosis?

Ultrasonography Signup and view all the answers

What is a common intervention to manage lymphedema?

Participating in active and passive exercises Signup and view all the answers

Which sign indicates potential hematoma formation post-surgery?

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

Which statement is true regarding post-operative nursing education after a mastectomy?

Avoiding injections in the affected arm is essential. Signup and view all the answers

What is a common side effect of chemotherapy that patients should be aware of?

Xerostomia/mouth ulcers Signup and view all the answers

What is a recommended nursing management action for a patient experiencing mucositis?

Provide normal saline mouth rinses Signup and view all the answers

What is an important nursing intervention related to skin care during radiation therapy?

Using mild soap with minimal rubbing Signup and view all the answers

Which medication is known to boost white blood cell production in cancer patients?

Filgrastim (Neupogen) Signup and view all the answers

When should external beam radiation therapy usually begin for patients?

After chemotherapy Signup and view all the answers

Which of the following symptoms should patients closely monitor after surgery?

Difficulty in breathing Signup and view all the answers

What is a common post-operative complication that requires drainage?

Hematoma Signup and view all the answers

Study Notes

Health Assessment

General assessment includes determining the onset of breast disorders, social history, medication review, and symptoms like masses, pain, swelling, or nipple discharge.
Best time for self-breast exams is 5-7 days after menses; report abnormalities to a healthcare provider.
Clinical breast exams recommended every three years in 20s-30s and monthly for post-menopausal women. Starting at 40, annual exams and mammograms are recommended.

Inspection and Palpation

Skin inspection: look for color changes, skin thickening, edema, or prominent veins indicating increased blood supply.
Erythema may suggest benign inflammation or malignancy; edema and pitting indicate venous drainage issues.
Paget's disease: erythema of nipple and areola; peau d’orange is a sign of advanced inflammatory conditions.
Tail of Spence: important area to examine as it is a common tumor site; palpate from outer edge to nipple while observing for dimpling or retraction.

Mammography

Mammography is the gold standard for detecting non-palpable lesions and should start at age 45 or 10 years earlier than the age of relative diagnosis.
Young women may present diagnostic challenges due to dense breast tissue; small amount of radiation exposure occurs during the procedure.

Other Diagnostics

Ultrasonography differentiates fluid-filled cysts from other lesions; cannot rule out malignancy.
Galactography aids diagnosis for nipple discharge by injecting radiopaque material to visualize ductal issues.
MRI utilizes IV contrast and is useful in complex cases, such as multifocal lesions or monitoring treatment response.
Fine needle aspiration and core needle aspiration are biopsy methods used to obtain tissue for histopathologic analysis.

Benign Conditions of the Breast

Mastalgia can be cyclical and is often linked to hormonal changes.
Breast cysts are common in women aged 30-55 and are typically tender.
Fibroadenomas are benign, movable tumors, and fibrocystic disease may be a precursor to breast cancer.
Benign proliferative disorders like atypical hyperplasia increase the risk of breast cancer.

Breast Malignancy

DCIS involves malignant cells within milk ducts without invasion; detected on mammograms as calcifications.
Medical management may include mastectomy for early detected cases.
Risk factors encompass early menarche, family history, age, obesity, and hormonal influences; genetic mutations (e.g., BRCA1/BRCA2) are significant.

Protective Factors and Clinical Manifestations

Chemoprevention options like tamoxifen and raloxifene can reduce cancer risk; regular physical activity and breastfeeding also provide protection.
Common manifestations of breast cancer include fixed, hard lumps with irregular borders, skin dimpling, and pain.

Staging and Prognosis

Staging utilized TNM classification: tumor size, lymph node involvement, and metastasis.
Prognosis depends on tumor size and spread; early-stage cancer has a much better survival rate.

Surgical Management

Total mastectomy involves removing the entire breast, while a modified radical mastectomy includes lymph node dissection.
Post-mastectomy patients are susceptible to lymphedema and reduced range of motion in operative limbs.

Complications and Nursing Management

Lymphedema management includes exercise, compression devices, and care for drain sites post-surgery.
Hematomas and seromas may form and require monitoring for treatment or drainage.

Chemotherapy

Chemotherapy regimens are specific to the type of cancer and may include agents such as CMF.
Common side effects include nausea, hair loss, and bone marrow suppression; supportive medications are crucial for managing these effects.

Reconstruction and Emotional Support

Post-mastectomy reconstruction can improve emotional well-being, with techniques ranging from tissue expanders to prosthetics.
Comprehensive care includes assessing patient's self-care abilities, providing education, and emotional support throughout treatment and recovery.

Health Assessment

Assess for general onset of breast disorders, duration of symptoms, and medication history.
Examine social history for habits impacting breast health; look for masses, pain, swelling, redness, or skin changes.
Document any recent test results, including nipple discharge findings.

Guidelines for Breast Examination

Best time for self-breast exam in women of childbearing age is 5-7 days post-menses.
Any abnormalities should be promptly reported to healthcare providers.
Clinical breast exams are recommended every three years in 20s-30s and monthly for post-menopausal women.
From age 40, annual breast exams and mammograms are advised.

Inspection and Palpation Techniques

Initial inspection should check skin for coloring, venous patterns, thickening, or edema.
Erythema may signal benign inflammation or possible malignancy.
Prominent veins can indicate increased blood supply due to tumors (angiogenesis).
Signs of potential malignancy include ulcerations, rashes, or spontaneous nipple discharge.
‘Peau d’orange’ is a classic sign of advanced inflammatory breast disorder.

Palpation Details

The Tail of Spence, an area extending into the axilla, must be examined due to its risk for tumors.
Palpation should be performed in both sitting and lying positions, checking each breast's entire surface.

Mammography

Gold standard for detecting non-palpable lesions and diagnosing palpable masses; can identify lesions under 1 cm.
Screening should start 10 years earlier than the age at which a relative was diagnosed with breast cancer.
Women are encouraged to begin mammograms at age 45, with two views taken per breast.

Other Diagnostic Tools

Ultrasonography distinguishes fluid-filled cysts from other lesions; cysts appear dark on imaging.
Galactography is used for diagnosing issues related to nipple discharge or dilated ducts.
MRI is particularly useful for multifocal cancers and monitoring treatment response.
Fine Needle Aspiration provides histopathologic analysis through a small gauge needle.

Benign Conditions of the Breast

Breast pain, or "mastalgia," can be cyclical, typically linked to hormonal changes or trauma.
Cysts are common fluid-filled sacs in women aged 30-55; they are usually tender.
Fibroadenomas are non-tender, firm tumors that can be movable.
Benign proliferative disorders include atypical hyperplasia, which elevates cancer risk.

Breast Malignancy

DCIS involves malignant cells in milk ducts without tissue invasion; detected by calcification on mammograms.
Early-stage treatment may involve mastectomy; breast conservation therapy is an option for some.

Risk Factors for Breast Cancer

Factors include early menarche, family history, ionizing radiation exposure, obesity, and late menopause.
Genetic mutations (BRCA1 and BRCA2) significantly increase risk.
Noteworthy protective factors include chemoprevention with tamoxifen and raloxifene, physical activity, and breastfeeding.

Clinical Manifestations of Breast Cancer

Significant signs include fixed tumors with irregular borders, skin dimpling, retraction, and possible tenderness.
Metastatic spread commonly involves bones and axillary lymph nodes; tumors are typically found in the upper outer quadrants.

Staging and Prognosis

TNM system assesses tumor size, lymph node involvement, and metastasis extent to determine stage.
Smaller tumor size correlates with better prognosis; 5-year survival rates decline with advancing stage.

Surgical Management

Modified radical mastectomy includes axillary lymph node dissection.
Post-operative care focuses on lymphedema prevention, range of motion maintenance, and monitoring for complications like hematomas and seromas.

Nursing Education and Management

Pre/post-operative education includes self-care, drain management, and arm exercises.
Discuss activity restrictions post-surgery, emphasizing care of the surgical site and potential complications.

Radiation and Chemotherapy

External beam radiation typically follows surgical treatment, lasting about six weeks.
Chemotherapy regimens may combine various agents, with common side effects including nausea, hair loss, and mucositis.

Recurrent Cancer and Reconstruction

Determine prognosis and treatment options for recurrent cancer; supportive care is vital.
Reconstruction can improve body image; options include tissue expanders and prosthetics, discussed in detail with patients.

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Description

This quiz covers essential aspects of breast health assessment, including general assessments, self-examination procedures, and clinical guidelines. It delves into inspection techniques and signs to look for during physical examinations, such as skin changes and areas of concern. Test your knowledge about breast health practices and recommendations for both young and post-menopausal women.