Assessment of the Breasts PDF

Assessment of the Breast Lakeland Community College Department of Nursing NURS 1090  Unit Outcomes Identify importance of assessment of the breasts Identify techniques used to assess the breasts. Identify physical assessment changes in the older adult. Identify principl...

Assessment of the Breast Lakeland Community College Department of Nursing NURS 1090  Unit Outcomes Identify importance of assessment of the breasts Identify techniques used to assess the breasts. Identify physical assessment changes in the older adult. Identify principles of heat and cold applications. Nursing History Reason for seeking care Breast pain or tenderness, nipple discharge, rash, lumps Medical History Breast disorders such as breast lumps, trauma, biopsy, surgery, cancer Medications such as oral contraceptives, estrogen, steroids, digitalis, and diuretics. Nursing History Does patient have any risk factors that may be associated with development of breast cancer? Mother, sister, aunt with breast cancer Alcohol consumption High-fat diet Obesity Use of oral contraceptives Menarche before age 12 Menopause after age 55 Age 30 or more at first pregnancy Physical Assessment of Breasts Two components Inspection & palpation Performed with patient sitting & supine  Inspection of the Breast Size, symmetry, and contour Generally symmetric May be slightly unequal in size Side of dominant arm may be slightly larger  Inspection of Breast Rounded shape No retractions, puckering, dimpling Color Flesh tone, uniform Skin surface Smooth and intact Striae, moles, nevi are normal variants Abnormalities Edema, discoloration, orange peel appearance, redness  Inspection of Areola Size, shape, Areola symmetry Round or oval and bilaterally the same Color Varies from light pink to dark brown Abnormalities Any asymmetry, Pearson, 2019 mass, or lesion Inspection of Nipple Size, shape, position Round, everted, and equal in size Color, discharge, lesions Similar in color Soft, smooth Point in same direction Abnormalities Pearson, 2019 Asymmetrical size and color Discharge Nipple Recent inversion of one or both nipples Palpation of Breast Pads of 3 middle fingers Use gently, rotary motion Start & end at a fixed point Pay extra attention to the upper outer quadrant & Tail of Palpatory Techniques Vertical strip method Circular method Wedged method (Methods explained on next slides) If patient reports a lump, pain or tenderness Start exam with the normal breast Note: Tail of Spence Palpatory Techniques Vertical strip method Up and down pattern- *recommended by American Cancer Society Circular Pattern Wedged Method (also known as hands-of-the-clock or Spokes-on-a-wheel) Palpate for the following: Temperature - uniform Consistency - firm, smooth, elastic Post menopausal - flaccid, pendulous Tenderness - none Masses - none Inferior aspect breast firmer due to the transverse inframammary ridge Nipple - don non-sterile gloves Compress nipple for discharge and describe Normal – no discharge Palpate Lymph Nodes All lymph nodes are normally non- palpable 1. Axillary - palpate 4 areas Refer to Pearson, Volume 3, p. 37 2. Supraclavicular 3. Infraclavicular palpate bilaterally & simultaneously standing in front of the patient Lymph Nodes Normal Breast Changes in Older Adult Glandular tissue atrophy Replaced with adipose tissue Breasts are softer, elongated, pendulous Skin Begins to wrinkle Loose, flabby Nipples Become smaller, flatter, shrink May invert Loss of erectile ability  Clinical & Breast Self Exam Breast exams can be done 2 ways: 1. Clinical Breast Exam (by health care provider) 2. Breast Self-Examination Both no longer recommended by the American Cancer Society (2017) due to lack of evidence but may still be recommended by health care provider based on patient condition and history.  Breast Self Exam (BSE) Nurse must be familiar with Breast Self exam process If menstruating, perform monthly, 2-3 days after period ends when breasts are least likely to be swollen and tender. If menstruation has ceased, perform on the same day monthly  Male Breasts Breast cancer in men is relatively rare. However… Men with mother or sister with a history of breast cancer are at risk for breast cancer http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/Patient/page1 Male – for those that are high risk: Inspect breasts for size, symmetry, and shape Normal: breasts should be even with the chest wall If male is obese, breast may be similar in shape to female breasts Inspect nipple and areola Palpate for masses Same as female Documentation of abnormal findings Location Size & shape Consistency Mobility Skin over the lump Nipple Tenderness