Breast And Axilla.330.Gsu


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Breast And Axilla.330.Gsu

  1. 1. Breast and Axilla Nursing 330 Governors State University Shirley Comer
  2. 2. Relevant History <ul><li>Pain lump </li></ul><ul><li>Discharge Rash </li></ul><ul><li>Swelling Trauma </li></ul><ul><li>Surgery Self exam practices </li></ul><ul><li>Tenderness </li></ul><ul><li>Breast Cancer can occur in men </li></ul>
  3. 3. Inspection <ul><li>Size and symmetry </li></ul><ul><ul><li>One breast may normally be slightly larger than the other </li></ul></ul><ul><li>Skin </li></ul><ul><ul><li>Smooth, non reddened </li></ul></ul><ul><ul><li>No bulges or dimpling </li></ul></ul><ul><ul><li>Fine blue veins normal as are striae </li></ul></ul><ul><li>Nipple </li></ul><ul><ul><li>Position and direction of nipple point </li></ul></ul><ul><ul><li>No discharge or retraction </li></ul></ul><ul><ul><li>Note lesions in nursing mothers </li></ul></ul>
  4. 4. Screen for Retractions <ul><li>Retraction is dimpling or puckering </li></ul><ul><li>Ask pt to bend at the waist </li></ul><ul><li>Ask to lift arms </li></ul><ul><ul><li>should move symmetrically </li></ul></ul><ul><li>Ask to put hands on hips </li></ul><ul><ul><li>observe position </li></ul></ul><ul><li>Ask to press hands together </li></ul><ul><ul><li>should move together </li></ul></ul>
  5. 5. Inspect and Palpate the Axillae <ul><li>Inspect skin </li></ul><ul><li>Support patient’s arm </li></ul><ul><li>Move fingers on a circular position through axillae </li></ul><ul><ul><li>Normally nodes not palpable </li></ul></ul><ul><ul><li>Nodes enlarge with local infection and breast cancer with metastases </li></ul></ul>
  6. 6. Breast Palpation <ul><li>Patient should be supine (lying down) </li></ul><ul><li>Place a small towel under shoulder on side to be assessed </li></ul><ul><li>Raise pt arm over her head </li></ul><ul><li>Use pads of 1 st three finger to palpate in a rotary motion </li></ul><ul><li>Assess entire breast using light, medium and then deep palpation </li></ul><ul><li>Cover entire breast- any pattern acceptable </li></ul>
  7. 7. Use the Middle of Your Fingers Fingertips are too sensitive (all breasts are somewhat lumpy) Palm is too insensitive Middle portion of fingers is just right
  8. 8. Palpation cont <ul><li>Nullaparus breasts feel firm and elastic </li></ul><ul><li>Post parus breasts feel softer and looser </li></ul><ul><li>Premenstrual tenderness is common r/t increased progesterone levels </li></ul><ul><li>Heat, Redness, and swelling in non lactating breasts indicate inflammation </li></ul>
  9. 9. Palpate Nipple <ul><li>Note any indurations or masses </li></ul><ul><li>Gently squeeze nipple </li></ul><ul><ul><li>note any discharge ie color, consistency, odor </li></ul></ul><ul><li>Except in pregnancy and lactation discharge is abnormal </li></ul><ul><li>Lactating women often have chaffed or sore nipples </li></ul>
  10. 10. Palpation Technique Work your way around the breast in a clockwise fashion, using small circles of the hand as you go. Make sure the entire breast is felt.
  11. 11. Tail of Spence
  12. 12. If Lumps found then Assess: <ul><li>Location </li></ul><ul><li>Size </li></ul><ul><li>Shape </li></ul><ul><li>Consistency </li></ul><ul><li>Moveable </li></ul><ul><li>Tenderness </li></ul><ul><li>Distinctness </li></ul>
  13. 13. Male Breasts <ul><li>Normal male breasts have flat disk of undeveloped breast tissue beneath nipple </li></ul><ul><li>Gynecomastia is enlargement of male breast tissue </li></ul><ul><ul><li>Can result from hormone, drug SE or disease process </li></ul></ul><ul><ul><li>May occur normally in adolescence </li></ul></ul><ul><ul><ul><li>Temporary </li></ul></ul></ul><ul><ul><ul><li>Often unilateral </li></ul></ul></ul>
  14. 14. ACS Changes to Recommendations <ul><li>Clinical Breast Exam </li></ul><ul><ul><li>20’s-30’s = every 3 years </li></ul></ul><ul><ul><li>After 40 = every year </li></ul></ul><ul><li>Mammography </li></ul><ul><ul><li>Every Year Beginning at age 40 </li></ul></ul><ul><li>MRI yearly for high risk women </li></ul><ul><ul><li>BRAC gene </li></ul></ul><ul><ul><li>1 st degree relative </li></ul></ul><ul><li>Monthly self breast exam= optional </li></ul>
  15. 15. Age Specific Considerations <ul><li>Infants ‘witch’s Milk” may be secreted in 1 st weeks of life </li></ul><ul><ul><li>Breasts may be slightly enlarged </li></ul></ul><ul><li>Adolescent female breast development occurs between 9 to 13 yo </li></ul><ul><ul><li>can be delayed by poor nutrition or hormone imbalance </li></ul></ul><ul><ul><li>lumps are usually benign cysts </li></ul></ul>
  16. 16. Pregnant Female <ul><li>Breasts and nipples Increase in size </li></ul><ul><li>Vascularity may become more visible </li></ul><ul><li>Striae may appear </li></ul><ul><li>Nipples become darker and more erect </li></ul><ul><li>Areola widen and contain small scattered Montgomery’s glands </li></ul><ul><li>May express thick yell colostrum /p 1 st trimester </li></ul>
  17. 17. Lactating Female <ul><li>Colostrum changes to milk approx 3 rd day post partum </li></ul><ul><li>Breasts become engorged, reddened and shinny </li></ul><ul><li>May feel warm </li></ul><ul><li>Nipples sore and may crack </li></ul><ul><li>Frequent nursing is best treatment for engorged and sore breasts </li></ul>
  18. 18. Aging Breast <ul><li>May become pendulous an flattened </li></ul><ul><li>Nipples may retract but should be easily pulled outward </li></ul><ul><li>Feels granular with prominent milk ducts </li></ul><ul><li>Women over 50 have increased risk of breast cancer </li></ul><ul><li>Stress Self breast exam </li></ul>
  19. 19. Self Breast Exam <ul><li>Instruct women to do monthly </li></ul><ul><li>If premenapausal-do on last day on menstrual flow </li></ul><ul><li>If post menopausal or irregular menses-do on the same day every month </li></ul><ul><li>Men can also benefit from monthly self exam </li></ul><ul><li>Report any abnormal findings or changes in tissue to Doctor </li></ul>
  20. 20. Practice Exam Question <ul><li>Your sister has fibrocystic disease of the breasts and consequently has many lumps in her breast. She mentions to you that she felt a new hard, unmovable lump this month. What would you advise her to do? </li></ul><ul><li>A. disregard it. It is probably another cyst </li></ul><ul><li>B. check to see if it is bigger next month </li></ul><ul><li>C. tell her doctor about it at her next yearly pap smear </li></ul><ul><li>D. Make an appoint to see her doctor ASAP </li></ul>
  21. 21. Rationale <ul><li>D is the correct answer. A malignant mass is frequently hard and unmovable. Early detection increases her treatment options. </li></ul>