ASSESSING THE BREASTS

1. ASSESSING THE BREASTS NUR211 Kathleen Hancock

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

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

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

9. FunctionsWhat 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. 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)

11. FunctionsWhat 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 • Self Breast Exam (SBE) • Every month • Mammogram • After age 40 every year • More frequent if personal or family history • Breast Exam by nurse or doctor every year

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

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

15. SymptomsWhat symptoms signal a problem with the breasts? • Breast lump or mass • Pain or tenderness • 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 • Approach: supine with pillow or towel under shoulder • Pattern (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 • Cover all of breast • Use 3 middle finger pads, not tips • Use sliding motion • Overlapping dime size circles • 3 pressure levels: light, medium, deep • Include nipple and areola

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

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

33. Male Breast Enlargement: • Gynecomastia

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

35. 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