1. ASSESSING THE BREASTS

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

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

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

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

6. 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)

7. 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)

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

9. The Breast

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

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

12. 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)

13. 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

14. 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

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

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

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

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

19. Palpation of Breast

20. 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

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

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

23. Location of Lymph

24. Lymph Node Palpation

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

26. 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

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