Breast And Axilla.330.Gsu

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  • 1. Breast and Axilla Nursing 330 Governors State University Shirley Comer
  • 2. Relevant History
    • Pain lump
    • Discharge Rash
    • Swelling Trauma
    • Surgery Self exam practices
    • Tenderness
    • Breast Cancer can occur in men
  • 3. Inspection
    • Size and symmetry
      • One breast may normally be slightly larger than the other
    • Skin
      • Smooth, non reddened
      • No bulges or dimpling
      • Fine blue veins normal as are striae
    • Nipple
      • Position and direction of nipple point
      • No discharge or retraction
      • Note lesions in nursing mothers
  • 4. Screen for Retractions
    • Retraction is dimpling or puckering
    • Ask pt to bend at the waist
    • Ask to lift arms
      • should move symmetrically
    • Ask to put hands on hips
      • observe position
    • Ask to press hands together
      • should move together
  • 5. Inspect and Palpate the Axillae
    • Inspect skin
    • Support patient’s arm
    • Move fingers on a circular position through axillae
      • Normally nodes not palpable
      • Nodes enlarge with local infection and breast cancer with metastases
  • 6. Breast Palpation
    • Patient should be supine (lying down)
    • Place a small towel under shoulder on side to be assessed
    • Raise pt arm over her head
    • Use pads of 1 st three finger to palpate in a rotary motion
    • Assess entire breast using light, medium and then deep palpation
    • Cover entire breast- any pattern acceptable
  • 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. Palpation cont
    • Nullaparus breasts feel firm and elastic
    • Post parus breasts feel softer and looser
    • Premenstrual tenderness is common r/t increased progesterone levels
    • Heat, Redness, and swelling in non lactating breasts indicate inflammation
  • 9. Palpate Nipple
    • Note any indurations or masses
    • Gently squeeze nipple
      • note any discharge ie color, consistency, odor
    • Except in pregnancy and lactation discharge is abnormal
    • Lactating women often have chaffed or sore nipples
  • 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. Tail of Spence
  • 12. If Lumps found then Assess:
    • Location
    • Size
    • Shape
    • Consistency
    • Moveable
    • Tenderness
    • Distinctness
  • 13. Male Breasts
    • Normal male breasts have flat disk of undeveloped breast tissue beneath nipple
    • Gynecomastia is enlargement of male breast tissue
      • Can result from hormone, drug SE or disease process
      • May occur normally in adolescence
        • Temporary
        • Often unilateral
  • 14. ACS Changes to Recommendations http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp?sitearea=
    • Clinical Breast Exam
      • 20’s-30’s = every 3 years
      • After 40 = every year
    • Mammography
      • Every Year Beginning at age 40
    • MRI yearly for high risk women
      • BRAC gene
      • 1 st degree relative
    • Monthly self breast exam= optional
  • 15. Age Specific Considerations
    • Infants ‘witch’s Milk” may be secreted in 1 st weeks of life
      • Breasts may be slightly enlarged
    • Adolescent female breast development occurs between 9 to 13 yo
      • can be delayed by poor nutrition or hormone imbalance
      • lumps are usually benign cysts
  • 16. Pregnant Female
    • Breasts and nipples Increase in size
    • Vascularity may become more visible
    • Striae may appear
    • Nipples become darker and more erect
    • Areola widen and contain small scattered Montgomery’s glands
    • May express thick yell colostrum /p 1 st trimester
  • 17. Lactating Female
    • Colostrum changes to milk approx 3 rd day post partum
    • Breasts become engorged, reddened and shinny
    • May feel warm
    • Nipples sore and may crack
    • Frequent nursing is best treatment for engorged and sore breasts
  • 18. Aging Breast
    • May become pendulous an flattened
    • Nipples may retract but should be easily pulled outward
    • Feels granular with prominent milk ducts
    • Women over 50 have increased risk of breast cancer
    • Stress Self breast exam
  • 19. Self Breast Exam
    • Instruct women to do monthly
    • If premenapausal-do on last day on menstrual flow
    • If post menopausal or irregular menses-do on the same day every month
    • Men can also benefit from monthly self exam
    • Report any abnormal findings or changes in tissue to Doctor
  • 20. Practice Exam Question
    • 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?
    • A. disregard it. It is probably another cyst
    • B. check to see if it is bigger next month
    • C. tell her doctor about it at her next yearly pap smear
    • D. Make an appoint to see her doctor ASAP
  • 21. Rationale
    • D is the correct answer. A malignant mass is frequently hard and unmovable. Early detection increases her treatment options.