ASSESSING THE BREASTS

Outcomes Identify pertinent breast history questions. Obtain a breast history. Perform a breast physical assessment. Document breast assessment findings. (Continued)

Outcomes Identify actual/potential health problems stated as nursing diagnosis. Differentiate between normal and abnormal findings.

Structures Lobes and lobules Lactiferous ducts and sinuses Areola Montgomery’s glands

Structures Nipple Cooper’s ligament Pectoralis major and serratus anterior muscles

Functions What are the functions of… Lobes & lobules: Contain acini cells that produce milk Lactiferous ducts & sinuses: Carry and store milk Areola: Dark tissue surrounding nipple (Continued)

Functions What are the functions of… Montgomery’s glands: Sebaceous gland Nipple: Nursing and sexual stimulation Cooper’s Ligament: Ligament attached to chest wall muscles that supports breasts (Continued)

Functions What are the functions of… Pectoralis major & serratus anterior muscles: Breast overlies these muscles Lymph nodes: Drain breast, chest, and arms

The Breast

Relationship to Other Systems What is the relationship of the breasts to other systems? Integumentary Respiratory Cardiovascular Musculoskeletal Neurological Reproductive Lymphatic Endocrine

Developmental Variations What developmental breast variations might be seen with: Children Pregnant clients Older adults

Cultural Variations What cultural variations of the breast might be seen with: African Americans (lower survival rate) Jews (greater incidence than other ethnic groups) Whites (highest incident rate)

Case Study Lynn Kobrynski, 46-year-old, married “My husband thinks I have a lump in my right breast.” Has not had a complete physical in 5 years

History What can the history tell you about the breast? Biographical data Current health status Past Health History Family history Review of systems Psychosocial history

Symptoms What symptoms signal a problem with the breasts? Breast lump or mass Pain or tenderness Nipple discharge Dimpling

Pertinent History Findings C/O “Lump in my right breast” Active and healthy; last physical 5 years ago No children, never pregnant (Continued)

Pertinent History Findings + Family history of breast cancer Does not perform BSE; never had mammogram Menarche age 12; cycle 28 days

Physical Assessment Anatomical landmarks: quadrants of the breast, include Tail of Spence Approach: inspection, palpation (vertical, wedge, or circular) light, medium, and deep (Continued)

Palpation of Breast

Physical Assessment Position: sitting, hands on hips, hands over head, leaning forward, and supine with pillow under shoulder Tools: small pillow or towel, ruler, gloves, slide, and culture slide. General survey and head-to-toe scan

Inspection Breasts: size, shape, symmetry, color, lesions, venous pattern, dimpling, or retraction Nipple and areola: nipple position and direction; discharge Axillae: color, lesions, rashes

Palpation Breasts: consistency, masses, tenderness Nipple: elasticity, masses, tenderness, discharge Lymph nodes: axillary, epitrochlear, and clavicular

Location of Lymph

Lymph Node Palpation

Characteristics of Masses Note: Size  Shape Mobility  Tenderness Consistency  Dilatation Temperature  Redness

Pertinent Physical Findings Right breast larger than left No dimpling, retraction Small, pea size (0.5cm), movable, rubbery, smooth-edged lesion in right breast at 2 o’clock in RUQ No palpable nodes

Nursing Diagnosis What actual or potential problems can you identify for Mrs. Kabrynski?