Health & Physical Assessment in Nursing PDF

Health & Physical Assessment in Nursing THIRD EDITION CHAPTER 5 Breasts and Axillae Copyr...

Health & Physical Assessment in Nursing THIRD EDITION CHAPTER 5 Breasts and Axillae Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Objectives Review of Anatomy and Physiology of Breasts and Axillae Discuss the different Assessment Techniques in Breasts and Axillae Discuss the different Abnormal Findings related to Breasts and Axillae List the secondary data related to assessment of Breasts and Axillae conditions Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Anatomy and Physiology Review Located on anterior chest Supported by muscles and ligaments Includes areola, nipple, and glandular, adipose, and fibrous tissue System of lymph nodes Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Breasts Paired mammary glands on the anterior chest wall Glandular, fibrous, and adipose tissue Components vary in proportion with age, general health, and hormonal states Nipple Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Anterior and lateral views of breast anatomy. Mammary ridge. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Breasts Areola Montgomery's glands or tubercles Axillary tail (tail of Spence) Suspensory ligaments (Cooper's ligaments) Mammary ridge Quadrants – Clinical findings described according to clock positions Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Supernumerary nipple. Breast quadrants. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Axillae and Lymph Nodes Drain lymph and return it to blood Superficial and deep Usually nonpalpable Internal nodes drain toward abdomen and opposite breast. Male breast has same potential to develop cancer. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Axillae and Lymph Nodes Nodes palpated during assessment – Internal mammary – Supraclavicular – Subclavicular – Interpectoral – Central axillary – Brachial – Subscapular – Pectoral Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Muscles of the Chest Wall Pectoralis major Serratus anterior Overall contour determined by suspensory ligaments Major function of muscles of chest wall to support breast and lymphatic tissue Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Lifespan Considerations Infants and children – Infants' breast tissue may be swollen. – Infants may produce a thin discharge called "witch's milk." – Breast tissue begins to enlarge in females with the onset of puberty. § Breast budding, often the first pubertal sign continued on next slide Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.8 Tanner's stages of breast development: I, Preadolescent. Only the nipple is raised above the level of the breast, as in the child. II, Budding stage. Areola increased in diameter and surrounding area slightly elevated. III, Breast and areola enlarged. No contour separation. IV, Areola forms a secondary elevation above that of the breast in half of girls. V, Areola is usually part of the general breast contour and is strongly pigmented. Nipple usually projects. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Lifespan Considerations Infants and children – Benign fibroadenomas (a painless, unilateral, benign (non-cancerous) breast tumor that is a solid, not fluid-filled, lump) in adolescent females are common. – Adolescent males may experience gynecomastia (an overdevelopment or enlargement of the breast tissue in men or boys) in puberty. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Lifespan Considerations The pregnant female – Enlargement of breast tissue for lactation – Pigmentation changes – Colostrum leakage prior to childbirth Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Lifespan Considerations The older adult – Limited range of motion for examinations – Modifications for breast self-examination – Changes in breast tissue composition – Gynecomastia in males – Breast cancer risk increases with aging. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Psychosocial Considerations Self-esteem and femininity – Idealized images of "perfect" breasts Fear of performing breast self- examinations – Men may delay reporting lumps Obesity and high-fat diets linked to breast cancer – May be due to lack of seeking breast screening Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Cultural and Environmental Considerations Females of African ancestry may develop breasts earlier than those of European ancestry. Axillary and pubic hair distribution may also vary with ancestry. Culture may contribute to feelings of embarrassment among various groups. Minority females may delay preventive or treatment measures due to lack of finances. Health & Physical Assessment in Nursing, Third Edition Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Focused Interview Consider information in relation to norms and expectations about breast and lymphatic function Mastalgia – Breast pain most often associated with the menstrual cycle – Rule out cardiac, pulmonary, and gastrointestinal causes of pain (OLDCART method) Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Focused Interview Focused interview questions – General, Illness or infection, Symptoms or behaviors – Age § Preadolescent § The pregnant female § The older adult – Environment § Internal § External Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Table 18.3 Overview of Mastalgia continued on next slide Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Table 18.3 (continued) Overview of Mastalgia continued on next slide Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Table 18.3 (continued) Overview of Mastalgia Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Assessment Techniques Inspection Palpation Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Assessment Techniques Inspection for size and symmetry Inspection for color, venous patterns, moles, or other markings Inspection of the areolae and nipples Observation of shape, surface characteristics, and suspensory ligaments Palpation of skin turgor and breast tissue Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Inspection of the breasts with the patient's arms above her head. Inspection of the breasts with the patient's hands pressed against her waist Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Inspection of the breasts with the patient's hands pressed together at the Assisting the patient to level of her waist. lean forward for inspection Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Assessment Techniques Palpation of the nipple and areolae, including compression Inspection and palpation of the axillae Palpating the breast Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.18a The vertical strip method for palpation of the breast. continued on next slide Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.18b The concentric circle pattern for palpation of the breast. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.19 Palpating a pendulous breast. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.20 Palpating the nipple. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.21 Palpating the axilla. Note that the nurse is supporting the woman's arm with her own nondominant arm. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.22 Palpation of the male breast. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Box 18.1 Teaching Breast Self-Examination continued on next slide Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Box 18.1 (continued) Teaching Breast Self- Examination continued on next slide Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Box 18.1 (continued) Teaching Breast Self- Examination Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Abnormal Findings Abnormalities of the female breast – Benign breast or fibrocystic disease § Characterized by lumps, pain or tenderness, and nipple discharge as a result of thickening of the breast tissue – Fibroadenoma § Mobile, firm, well-delineated lumps Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Fibroadenoma Fibrocystic breast disease. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Peau d'orange sign.- The skin becomes thick and pitted, with a texture and appearance similar to that of orange peel Paget's disease of the nipple.- a rare condition associated with breast cancer. It causes eczema-like changes to the skin of the nipple and the area of darker skin surrounding the nipple (areola Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Abnormal Findings Abnormalities of the female breast – Intraductal papillomas § Tiny growths of epithelial cells that project into the lactiferous ducts – Mammary duct ectasia § Inflammation of the lactiferous ducts behind the nipple – Breast cancer Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Intraductal papilloma. Mammary duct ectasia. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Abnormal Findings Abnormalities of the female breast – Breast cancer § Common signs – Dimpling of the skin – Deviation of the nipple – Nipple retraction – Change in the shape of one breast – Edema – Discharge Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Abnormal Findings Abnormalities of the male breast – Gynecomastia § Enlargement of male breast tissue – Carcinoma (cancer) § Less than 1% of all breast cancer occurs in men. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.28 Gynecomastia. Source: John Radcliffe/Science Source. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved Figure 18.29 Carcinoma of the breast. Source: JDP/Custom Medical Stock Photo. Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved  Table 18.2 Potential Secondary Sources for Patient Data Related to the Breast and Axillae Copyright © 2016, © 2012, © 2007 Health & Physical Assessment in Nursing, Third Edition by Pearson Education, Inc. Donita D'Amico | Colleen Barbarito All Rights Reserved