1. ASSESSING THE BREASTS NUR211 Kathleen Hancock

2. Assessing the Breasts 4 Obtain a breast history. 4 Perform a breast physical assessment. 4 Document breast assessment findings. 4Differentiate between normal and abnormal findings.

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

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

5. Structures 4 Nipple 4 Cooper’s ligament 4 Pectoralis major and serratus anterior muscles

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

10. 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)

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

12. Breast Health: Cancer Prevention 4Self Breast Exam (SBE) 4Every month 4Mammogram 4After age 40 every year 4More frequent if personal or family history 4Breast Exam by nurse or doctor every year

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

14. 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

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

16. Physical Assessment Anatomical landmarks: quadrants of the breast, include Tail of Spence (Continued)

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

18. Physical Exam - Inspection Position: sitting, hands on hips, hands over head, leaning forward Tools: small pillow or towel, ruler, gloves, slide, and culture slide.

19. Sitting, arms at sides

20. Arms overhead

21. Arms pressing on hips

22. Leaning forward

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

24. Supraclavicular Nodes

25. Infraclavicular Nodes

26. Axillary Nodes

28. Palpation –Vertical Strip Method Preferred 4 Approach: supine with pillow or towel under shoulder 4Pattern (vertical, wedge, or circular) light, medium, and deep

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

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

31. Large Breasts 4Bimanual palpation to adequately examine all areas 4Often have an inframammary ridge

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

33. Male Breast Enlargement: 4Gynecomastia

34. Characteristics of Masses Note: 4 Location  Shape/Borders 4 Size  Tenderness 4 Mobility  Consistency 4 Temperature  Redness

35. 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