1. ASSESSING THE BREASTS NUR211 Kathleen Hancock

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

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

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

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

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

8. 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)

9. 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)

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

11. Breast Health: Cancer Prevention 4Self Breast Exam (SBE) 4Every month 4Mammogram 4After age 50 every year 4More frequent if personal or family history 440-49 years every 1-2 years 4Breast Exam by nurse or doctor every year

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

15. 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

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

17. 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. 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

20. Sitting, arms at sides

21. Arms overhead

22. Arms pressing on hips

23. Leaning forward

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

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

26. Supraclavicular Nodes

27. Infraclavicular Nodes

28. Axillary Nodes

30. Palpate Epitrochlear Nodes

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

32. 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

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

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

35. Male Breast Enlargement: 4Gynecomastia

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

37. 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