Breasts and Regional Lymphatics

1. Breasts and Regional Lymphatics Chapter 17

2. Structure and Function • Subjective Data—Health History Questions • Objective Data—Physical Exam • Abnormal Findings

3. Structure and Function Surface anatomy • Location of breasts on chest wall • Axillary tail of Spence • Nipple and areola

4. Structure and Function(cont.)

5. Structure and Function (cont.) Internal anatomy • Glandular tissue • Lobes, lobules, and alveoli • Lactiferous ducts and sinuses • Fibrous tissue • Suspensory ligaments or Cooper’s ligaments • Adipose tissue Four quadrants of the breast

6. Structure and Function(cont.) Lymphatics • Axillary nodes • Central • Pectoral (anterior) • Subscapular (posterior) • Lateral • Drainage patterns

7. Developmental care Adolescent Puberty Pregnant female Aging female Menopause Male breast Cross-cultural care Breast cancer Structure and Function (cont.)

8. Subjective Data—Health History Questions • Breast • Pain • Lump • Discharge • Rash • Swelling • Trauma

9. Subjective Data—Health History Questions (cont.) • History of breast disease • Surgery • Self-care behaviors • Breast self-examination • Last mammogram • Axilla • Tenderness, lump, or swelling • Rash

10. 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

11. Objective Data—Physical Exam • Preparation • Position • Draping • Equipment • Small pillow • Ruler marked in centimeters • Pamphlet or teaching aid for breast self-examination

12. 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

13. Objective Data—Physical Exam (cont.) Breasts—Palpate • Position • Palpation patterns • Expected findings • Nipple • Bimanual palpation

14. Objective Data—Physical Exam (cont.) • If a lump is present, note • Location • Size • Shape • Consistency • Mobility • Distinctness • Nipple retraction • Overlying skin • Tenderness • Lymphadenopathy

15. Teach Breast Self-Examination • Schedule for self-exam • Correct technique • Return demonstration

16. Objective Data—Physical Exam (cont.) Male breast • Gynecomastia Developmental care • Infants and children • Adolescent • Pregnant female • Lactating female • Aging female

17. Sample Charting

18. Sample Charting (cont.)

19. Sample Charting (cont.)

20. Abnormal FindingsSigns of Retraction and Inflammation • Dimpling • Fixation • Edema (peau d’orange) • Deviation in nipple pointing • Nipple retraction

21. Abnormal Findings (cont.)Breast Lump • Benign breast disease (formerly fibrocysticbreast disease) • Cancer • Fibroadenoma

22. Abnormal Findings for Advanced PracticeAbnormal Nipple Discharge • Mammary duct ectasia • Carcinoma • Intraductal papilloma • Paget’s disease (intraductal carcinoma)

23. Abnormal Findings (cont.)Disorders During Lactation • Plugged duct • Breast abscess • Mastitis

24. Abnormal Findings (cont.)Male Breast • Gynecomastia • Carcinoma

25. Which of the following is not appropriate when teaching breast self-examination (BSE)? • Focus on the positive aspects of BSE. • Cite statistics regarding breast cancer. • Explain that most women never get breast cancer. • Keep your teaching simple.

26. Which would not be a consideration when examining a woman’s breasts? • 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.