Breast and auxillae

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Author:
leitogonza
ID:
290846
Filename:
Breast and auxillae
Updated:
2014-12-07 18:01:45
Tags:
advanced health assessment
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3
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  1. How findings in breasts should be described?
    • Divide the breast into 4 quadrants, horizontal and vertical lines crossing the nipple.
    • Note the tail of spence which extendes to anterior axillary fold.
    • note findings depending using clock locations. 
  2. Older adults differences when breast examining?
    • Gladular tissue atrophies and is replaced by fat, therfore, breasts become smaller.
    • Lower edge of the breast thickens.
    • hangs more loosely from the chest wall.
    • Nipples smaller, flatter, and loose some erectile ability.
    • Skin dry, thin, and loss of axillary hair.
  3. Childbearing differences?
    • Lactiferous ducts proliferte and alveoli increases in size and number. (2 to 3 times pre-pregnancy size)
    • Epithelial secretory activity increases, which leads to colostrum production (first fluid before milk comes)
    • Areolae deeply pigmented and diameter increases.
    • Nipple more prominent and darker.
    • Mammary vascularization increases, veins engorge, and visible blue network.
    • Colostrum secretion is normal in last trimester.
  4. Adolescents differences?
    • Thelarche: breast development.
    • Assymetry, it is possible bc breast can develop at different rates.
    • Around or before 10 yrs of age, both male and female breast are similar.
  5. What question should be asked when gathering health history?
    • Breast discomfort or pain? (related to menses, character, associated symptoms, contributing factors, meds)
    • Breast mass or lumps?
    • Nipple discharge?
    • Do u examine ur breasts? how often?
    • * 5-7 days after onset of menses is the ideal time for examination.
  6. How should the inspection be done?
    • Compare breast: size, symmetry, skin texture, contour (conical, convex, pendulous, large pendulous, right larger than left and vice versa), retractions of dimpling. 
    • Compare areolae and nipples: nipple inversion, eversion, or retraction, all the others. -- Supernumary nipple is not unusual that runs along the milk ductus line.
    • Position: arms at side, arms overhead, hands pressed against hips, leaning forward.
  7. How should palpation be done?
    • supine position w a pillow under shoulder of the breast being examined -- Hand at neck and elbow out.
    • Palpate from the axillae downward using verival lines up and down over breast tissue. (3 mins per breast, 2nd, 3th, 4th finger pads, vertical techique)
    • Palpate: tail of spence, lateral, medial, and nipple.
    • * Most cancers are in tail of spence and upper quadrant.
  8. what are finding that could Malignant?
    • Hard consistency.
    • Irregular shape.
    • Dimpling or overlying skin.
    • Associated retraction of nipple.
    • Non-tender.
  9. Breast exams recommendations?
    • 20-40 yrs old should have breast examination every 3 yrs.
    • Annually after 40.
    • Breast self exam are optional.
    • Mammograms recommended after 40. (new recommendations are after 50)
  10. What are breast factor for breast cancer?
    • Obesity.
    • Use of Hormonal replacement therapy (HRT)
    • Alcohol use.
    • Physical inactivity.
    • Age.
    • Family History (1st degree relative specially if dx premenopausal CA)
    • Late age for the 1st full term pregnancy.
    • Early menarche (8-10 yrs)
    • Late menopause.
    • Breast density.
    • BRCA 1 and BRCA 2 family.
    • Never breast fed.
  11. How to examine unique situations?
    • Breast implants: firmly inwards at the edge of the implants, trying to feel the ribs -- decreased the chances or mortality bc lumps r hard to find.
    • Mastectomy: Inspect the scar an axilla for possible return of malignancy. -- Lymphodema is normal.
  12. How to examine male breast?
    • inspect nipple and areola for swelling, nodules, and ulceration.
    • Palpate areola and breast.
    • Distinguish b/t fatty enlargements of obesity and firm disc of glandular (gynocomastia).
  13. How to examine the axillae?
    • pt sitting.
    • inspect rash, infection, unusual pigmentation.
    • fingers should be behind the pectoral muscles.
    • one or more soft, small, nontender nodes is normal.

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