NR509 Final Chapter 18 Breast and Axillae.pdf

NR 509 Final Exam Sudy Guide Review 2024 New Updaes Perec Revision Chapter 18 Breasts and Axillae Techniques o examinaon o Arms over head ▪ Can bring ou dimpling or reracon ha may b...

NR 509 Final Exam Sudy Guide Review 2024 New Updaes Perec Revision Chapter 18 Breasts and Axillae Techniques o examinaon o Arms over head ▪ Can bring ou dimpling or reracon ha may be invisible Palpae he breass ▪ Bes wih p. supine ▪ A horough examinaon akes a leas hree minues ▪ Use he vercal srip paern o deec breas mass ▪ Palpae in small, concenric circles applying ligh, medium, and deep pressure a each examining poin ▪ When pressing deeply on he breas a normal rib can be misaken or a hard breas mass ▪ To palpae laeral breas, ask paen o roll ono he opposie hip, placing her hand on her orehead bu keeping he shoulder pressed agains he bed or examining able as his aens he laeral breas ssue. ▪ To palpae he medial poron o he breas, have p. lie a wih shoulders agains he examining able ▪ Inspec he axillae ▪ Palpae he axillary nodes ▪ By moving in a sraigh line down he bra line, hen move ngers medially and palpae in a vercal rip up he ches o he clavicle. Anaomy o Female breas/axillae assessmen o Breas lump or mass ▪ Can be physiologic or pahologic ranging rom cyss and broadenomas o breas cancer o Breas cys ▪ Usually rm, round, mobile, and oen ender, mosly common beween ages o 25-50 years old o Breas discomor or pain ▪ SSRI, Haldol, Aldacone, and dig can cause breas pain Nipple discharge o Lymph nodes o The lymphac drainage o he breas is o grea imporance in he spread o carcinoma, and abou hree-quarers o i is o he axillary nodes. ▪ Cenral nodes (axillary) o The male breas o Gynecomasa: males who develop benign breas enlargemen. Causes include increased esrogen, decreased esoserone, and medicaon side eecs o Inspec he nipple and areola (nodules, swelling, ulceraon) o Palpae he areola and breas ssue (nodules) Breas cancer (including screening and risk acors)  o Redness suggess local inecon or inammaory carcinoma Thickening and prominen pores suggess breas cancer o Flang o he normally convex breass sugges cancer Asymmery in nipple direcon suggess cancer o Eczemaous changes wih rash scaling or ulceraon on he nipple exending o areola suggess Page disease o Invered nipple sugges cancer o Breas dimpling or reracon sugges cancer o Milky discharge unrelaed o pregnancy is nonpuerperal galacorrhea ▪ Caused by hypohyroidism, piuiary prolacnoma, and dopamine anagoniss o Risk acors ▪ Increasing age 65+ unl age 80 ▪ Biopsy: conrmed aypical hyperplasia ▪ Firs-degree amily members diagnosed wih breas cancer a an early age ▪ Inheried genec muaons- BRCA 1 and BRCA2 ▪ Personal hisory o breas cancer or ducal or lobular carcinoma ▪ Relavely denser breass on mammography ▪ High-dose radiaon o he ches a a young age ▪ High levels o endogenous hormones ▪ Age a rs ull erm pregnancy ▪ Lae menopause o Modiable risk acors ▪ Breasteeding or less han 1 year, posmenopausal obesiy, use o HRT, smoking, alcohol consumpon, physical inacviy, and ype o conracepon. Clinical breas examinaon (CBE) and sel-breas examinaon (SBE) echniques o The bes me is in a paen who is sll mensruang 5-7 days aer he onse o mensruaon because breass end o swell and become more nodular beore menses o Inspec breass in our views: arms a sides, arms over head, arms pressed agains hips, and leaning orward. o Breas sel-examinaon ▪ A high proporon o breas masses are deeced by women examining heir own breass. For screening, he BSE has no been shown o reduce breas cancer moraliy bu may promoe healh awareness and earlier reporng o breas changes or masses, which may reduce unnecessary esng and biopsies compared o monhly sel-examinaon. The BSE is bes med 5 o 7 days aer menses, when hormonal smulaon o breas ssue is low. Physiologic changes associaed wih he normal aging process o Fibroadenoma ▪ very mobile, round dislike, ypically small (1-2cm), rm, usually single bu very well delineaed. 15-25 years, pubery. o Cys ▪ mobile, round, well delineaed, so o rm, single, 30-50 years. o Cancer ▪ may be xed o he skin or underlying ssues, usually single, irregular or sellae in shape, rm or hard, mos common over age o 50 Lacaon o