Breasts and Regional Lymphatics Chapter 17 Elsevier items

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

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

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

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

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

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

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

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

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

Chapter 17: Breasts and Regional Lymphatics 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 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 17 -10

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

Chapter 17: Breasts and Regional Lymphatics 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 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 17 -12

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

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

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

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

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

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

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

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

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

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

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

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

Chapter 17: Breasts and Regional Lymphatics 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. D. Explain that most women never get breast cancer. Keep your teaching simple. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 17 -25

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