ASSESSING THE BREASTS

1. ASSESSING THE BREASTS NUR211 Kathleen Hancock

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

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

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

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

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

8. FunctionsWhat 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. FunctionsWhat 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. FunctionsWhat 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 • Self Breast Exam (SBE) • Every month • Mammogram • After age 50 every year • More frequent if personal or family history • 40-49 years every 1-2 years • Breast Exam by nurse or doctor every year

13. DevelopmentalVariations What developmental breast variations might be seen with: • Children • Pregnant clients • Older adults

15. HistoryWhat can the history tell you about the breast? • Biographical data • Current health status • Past health history • Family history • Review of systems • Psychosocial history

16. SymptomsWhat symptoms signal a problem with the breasts? • Breast lump or mass • Pain or tenderness • 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 • Cover all of breast • Use 3 middle finger pads, not tips • Use sliding motion • Overlapping dime size circles • 3 pressure levlels: light, medium, deep • Include nipple and areola

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

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

35. Male Breast Enlargement: • Gynecomastia

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

37. Example: 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