ASSESSING THE BREASTS NUR211 Kathleen Hancock

Outcomes 4 Obtain a breast history. 4 Perform a breast physical assessment. 4 Document breast assessment findings. 4 Identify pertinent breast history questions. (Continued)

Outcomes 4 Identify actual/potential health problems stated as nursing diagnosis. 4 Differentiate between normal and abnormal findings.

Breast Composition 43 types of tissue: 4*Glandular 4*Fibrous 4*Adipose

Structures 4 Lobes and lobules 4 Lactiferous ducts and sinuses 4 Areola 4 Montgomery’s glands

Structures 4 Nipple 4 Cooper’s ligament 4 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

Breast Health: Cancer Prevention 4Self Breast Exam (SBE) 4Every month 4Mammogram 4After age 50 every year 4More frequent if personal or family history years every 1-2 years 4Breast Exam by nurse or doctor every year

Developmental Variations What developmental breast variations might be seen with: 4Children 4Pregnant clients 4Older adults

History What can the history tell you about the breast? 4Biographical data 4Current health status 4Past health history 4Family history 4Review of systems 4Psychosocial history

Symptoms What symptoms signal a problem with the breasts? 4 Breast lump or mass 4 Pain or tenderness 4 Nipple discharge

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

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

Sitting, arms at sides

Arms overhead

Arms pressing on hips

Leaning forward

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 Lymph nodes: axillary, epitrochlear, clavicular while sitting Breasts: consistency, masses, tenderness in supine position Nipple: elasticity, masses, tenderness, discharge

Supraclavicular Nodes

Infraclavicular Nodes

Axillary Nodes

Palpate Epitrochlear Nodes

Supine with shoulder support –Use pads of fingers of dominant hand

Strip Method of Palpation 4Cover all of breast 4Use 3 middle finger pads, not tips 4Use sliding motion 4Overlapping dime size circles 43 pressure levlels: light, medium, deep 4Include nipple and areola

Large Breasts 4Bimanual palpation to adequately examine all areas 4Often have an intramammary ridge

Male Breast 4Palpation 4Inspection 4Lymph nodes while sitting 4Breast while sitting or if large while lying down

Male Breast Enlargement: 4Gynecomastia

Characteristics of Masses Note: 4 Size  Shape 4 Mobility  Tenderness 4 Consistency  Delimitation 4 Temperature  Redness

Example: Pertinent Physical Findings 4 Right breast larger than left 4 No dimpling, retraction 4 Small, pea size (0.5cm), movable, rubbery, smooth-edged lesion in right breast at 2 o’clock in RUQ 4 No palpable nodes