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 DataHealth History Questions

Objective DataPhysical 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.)

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YUV420 codec decompressor
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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

Lobes, lobules, and alveoli

Lactiferous ducts and sinuses

Fibrous tissue

Suspensory ligaments or
Coopers 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

Central

Pectoral (anterior)

Subscapular (posterior)

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

Pregnant female

Aging female

Breast cancer

Puberty

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

Pain

Lump

Discharge

Rash

Swelling

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.)

History of breast disease

Surgery

Self-care behaviors
Breast self-examination
Last mammogram

Axilla

Tenderness, lump, or swelling

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 DataPhysical Exam

Preparation

Position

Draping

Equipment

Small pillow

Ruler marked in centimeters

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 DataPhysical Exam

(cont.)

BreastsInspect
General appearance

Skin
Lymphatic drainage areas
Nipple
Maneuvers to screen for retraction

AxillaeInspect 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 DataPhysical Exam

(cont.)

BreastsPalpate

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 DataPhysical Exam

(cont.)

If a lump is present, note

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 DataPhysical 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 dorange)

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

Pagets 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 womans breasts?
A.

B.

C.

D.

In our culture, a womans breasts are crucial

to her self-concept.
Typically, a woman with a breast lump
assumes the worst outcome.
Asking questions about a womans 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