Assessing the Breasts health assessment (exam 2) – Flashcards
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1. What are the major risk factors for breast cancer?
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1. Age 65+ 2. Biopsy confirmed atypical hyperplasia 3. BRCA1 and/or BRCA2 4. Lobular carcinoma in situ 5. Dense breasts 6. Personal history early onset (<40 years) 7. 2 or more 1st degree relatives with BC at early age
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2. What are the typical historical and physical findings of benign breast disease, fibroadenoma, and breast cancer (study Table 17-4, p. 408 in text).
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1. Pain or tenderness, 2. Lump or thickening, 3. Nipple discharge, 4. Rash, 5. Swelling, 6. Trauma, 7. History of breast disease, 8. Surgery on the breasts, 9. And self-care behaviors, including the frequency of breast self-examinations and the last mammogram.
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3. In which part of the breast are most malignancies found in women? In men?
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In women (Axillary tail of spence) In men (beneath the areola usually with nipple discharge and fixation to skin)
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4. When is the best time of the month for women to do BSE (Breast Self-Exam) and why?
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right after the menstrual cycle, when the breasts are the smallest and least congested. If you have gone through menopause, do your exam on the same day every month.
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5. How is the female client positioned for inspection of the breast and palpation of the breast?
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sitting
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6. What is the procedure for screening women for nipple and skin retraction during a breast exam?
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ask the woman to raise her arms overhead. Then ask her to push her hands on her hips, leaning forward. This tests for retraction. Inspect and palpate the axillae and regional lymph nodes. • With the woman supine and her arms raised over her head, systematically palpate all four quadrants of the breasts, including the tail of Spence, the nipples, and the areolae.
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retraction:
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attachment to chest wall, usually from growing neoplasms.
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7. Review the discussion about inspection of the nipples, nipple inversion and nipple retraction, p. 395.
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Nipples - scaling, cracking, discharge, bleeding, recent inversion abnormal assess the nipples and areolae for symmetry, shape, and any abnormalities. Should be symmetric on same plane on both breasts. Nipples usually protrude, although some are flat and some are inverted. Normal nipple inversion may be unilateral or bilateral and usually can be pulled out. Note any dry scaling, any fissure or ulceration, and bleeding or other discharge. Recent inversion abnormal.
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8. What is the procedure for examining the breasts of the male?
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combine the breast examination with the anterior thorax examination. Inspect the chest wall, palpate the nipple area, and palpate the axillary lymph nodes.
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9. How does the nurse correctly chart a breast lump found on examination? (See page 400 and the Clinical Case Study 2, pp. 405-406)
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If you feel a lump or mass, note its location, size, shape, consistency, mobility, and distinctness. Also notice any related nipple changes, skin changes, tenderness, or lymphadenopathy.
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10. What are common assessment findings in the breasts of elderly and pregnant women? (see page 403 in text)
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elderly: After menopause, secretion of estrogen and progesterone decreases, causing glandular and fatty tissue to atrophy so that the breasts droop and sag. pregnante: During pregnancy, breast changes begin in the second month with the expansion of the ductal system and supporting fatty tissue and the development of the true secretory alveoli. Colostrum may be expressed after the fourth month.
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11. What is taught to patients to promote breast health? (pay particular attention to the notes on slides 21-22)
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Keep teaching clear and simple. The simpler the plan, the more likely person is to comply. Describe correct technique and rationale and expected findings to note as woman inspects her own breasts. Teach woman to do this in front of a mirror while she is disrobed to waist. At home, she can start palpation in shower, where soap and water assist palpation. Then palpation should be performed while lying supine. Encourage woman to palpate her own breasts while you monitor her technique.
