1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Breasts and Regional Lymphatics Chapter 17

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-2  Structure and Function  Subjective Data—Health History Questions  Objective Data—Physical Exam  Abnormal Findings

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-3 Structure and Function Surface anatomy  Location of breasts on chest wall  Axillary tail of Spence  Nipple and areola

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-4 Structure and Function (cont.)

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-5 Structure and Function (cont.) Internal anatomy  Glandular tissue  Lobes, lobules, and alveoli  Lactiferous ducts and sinuses  Fibrous tissue  Suspensory ligaments or Cooper’s ligaments  Adipose tissue Four quadrants of the breast

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-6 Structure and Function (cont.) Lymphatics  Axillary nodes  Central  Pectoral (anterior)  Subscapular (posterior)  Lateral  Drainage patterns

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-7 Structure and Function (cont.) Developmental care  Adolescent  Puberty  Pregnant female  Aging female  Menopause  Male breast Cross-cultural care  Breast cancer

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-8 Subjective Data— Health History Questions  Breast  Pain  Lump  Discharge  Rash  Swelling  Trauma

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-9 Subjective Data— Health History Questions (cont.)  History of breast disease  Surgery  Self-care behaviors Breast self-examination Breast self-examination Last mammogram Last mammogram  Axilla  Tenderness, lump, or swelling  Rash

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-10 Subjective Data— Health History Questions (cont.) Additional history for preadolescent  Changes in breasts  Other changes Additional history for pregnant female  Enlargement of breasts  Plans to breastfeed Additional history for menopausal woman  Changes in breasts

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-11 Objective Data—Physical Exam  Preparation  Position  Draping  Equipment  Small pillow  Ruler marked in centimeters  Pamphlet or teaching aid for breast self-examination

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-12 Objective Data—Physical Exam (cont.) Breasts—Inspect  General appearance  Skin  Lymphatic drainage areas  Nipple  Maneuvers to screen for retraction Axillae—Inspect and Palpate  Skin  Palpation technique  Lymph nodes

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-13 Objective Data—Physical Exam (cont.) Breasts—Palpate  Position  Palpation patterns  Expected findings  Nipple  Bimanual palpation

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-14 Objective Data—Physical Exam (cont.)  If a lump is present, note  Location  Size  Shape  Consistency  Mobility  Distinctness  Nipple retraction  Overlying skin  Tenderness  Lymphadenopathy

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-15 Teach Breast Self-Examination  Schedule for self-exam  Correct technique  Return demonstration

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-16 Objective Data—Physical Exam (cont.) Male breast  Gynecomastia Developmental care  Infants and children  Adolescent  Pregnant female  Lactating female  Aging female

17. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-17 Sample Charting

18. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-18 Sample Charting (cont.)

19. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-19 Sample Charting (cont.)

20. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-20 Abnormal Findings Signs of Retraction and Inflammation  Dimpling  Fixation  Edema (peau d’orange)  Deviation in nipple pointing  Nipple retraction

21. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-21 Abnormal Findings (cont.) Breast Lump  Benign breast disease (formerly fibrocystic breast disease)  Cancer  Fibroadenoma

22. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-22 Abnormal Findings for Advanced Practice Abnormal Nipple Discharge  Mammary duct ectasia  Carcinoma  Intraductal papilloma  Paget’s disease (intraductal carcinoma)

23. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-23 Abnormal Findings (cont.) Disorders During Lactation  Plugged duct  Breast abscess  Mastitis

24. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-24 Abnormal Findings (cont.) Male Breast  Gynecomastia  Carcinoma

25. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-25 Which of the following is not appropriate when teaching breast self-examination (BSE)? A.Focus on the positive aspects of BSE. B.Cite statistics regarding breast cancer. C.Explain that most women never get breast cancer. D.Keep your teaching simple.

26. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 17: Chapter 17: Breasts and Regional Lymphatics Slide 17-26 Which would not be a consideration when examining a woman’s breasts? A.In our culture, a woman’s breasts are crucial to her self-concept. B.Typically, a woman with a breast lump assumes the worst outcome. C.Asking questions about a woman’s breasts can trigger deep emotional responses. D.Most women respond to questions and the examination in much the same way.