Physical health Assessment

Breasts and Regional Nodes

Lecturer/ Hanaa Eisa

Learning out come

At the end of this Lesson the study participants will

be able to:

1. Describe the anatomy & physiology of the

breasts and regional lymphatics, including age

related variations.

2. Demonstrate assessment techniques for the

evaluation of the breasts and regional lymphatics.

3. Distinguish common variations and

abnormal changes of the breasts.

4. Discuss methods of teaching breast self-

examination to patients.

5. Identify risk factors for breast cancer.

Learning out come cont’d

Anatomy and physiologyof the breast

o Function: o Milk production .

o Tail of Spenceo Cooper’s ligamentso Nippleo Lactiferous ductso Areolao Montgomery’s tubercleso Lobeso Lobules

Anatomy and physiologyof the breast

o Alveoli or acinio Lymphatic drainage

o Axillary nodes: central, pectoral, subscapular, lateral

o Internal mammary chain

Anatomy and physiologyof the breast

Breast development

o Usually begins at 10 to 11 years of ageo Stimulated by estrogen release during puberty

Health history

Patient profileo Ageo Gendero Race

Common chief complaintso Breast mass, tenderness, dischargeo Assess the following characteristics

• Location• Quality• Quantity• Associated manifestations• Aggravating factors• Alleviating factors

Health history

Past health historyo Breast specific vs. Systemico Medicalo Surgicalo Medicationso Allergies

Health history

Family historyo Breast cancero Benign breast disease

Health history

Social historyo Alcohol useo Tobacco useo Work environmento Home environmento Economic statuso Ethnic background

Health history

Health maintenance activitieso Dieto Exerciseo Breast self-examo Mammogram

Health history

Assessment

Equipmento Towelo drapeo centimeter rulero teaching aid for breast self-exam

General approach Inspection Patient positions

Assess the following areaso Breastso Areolar areaso Nippleso Axillae

Assessment

Assess the following characteristics1. Color2. Vascularity3. Thickening/edema4. Size and symmetry5. Contour6. Lesions/masses7. Discharge

Assessment

Palpation

1. Sequential manner

2. Supraclavicular and Infraclavicular nodes

3. Breasts, arms at side, arms raised

4. Axillary nodes

5. Breasts, supine position

Evaluation of breast mass characteristics

1. Location

2. Size

3. Shape

4. Number

5. Consistency

Evaluation of breast mass characteristics

1. Definition

2. Mobility

3. Tenderness

4. Erythema

5. Dimpling or retraction

Normal findings

1. Breast and axillae are flesh colored

2. Areolar areas and nipples are darker in

pigmentation

3. Moles and nevi are normal variants

4. No thickening or edema

1. Minor size variation in the breasts and areolar areas

2. Usually breast on dominant side is larger

3. Nipples should point upward and outward, may point outward and downward

Normal findings

1. Breasts, areolar areas, nipples should be symmetrical

2. Breasts are convex, without flattening, retractions, or dimpling

3. Free from masses, tumors, primary or secondary lesions

Normal findings

1. No discharge from nipples in nonpregnant, nonlactating female

2. Usually, palpable lymph nodes less than 1 cm in diameter are clinically insignificant

3. Palpation should not elicit pain

Normal findings

1. Consistency of breast tissue is highly variable depending upon age, time in menstrual cycle, and proportion of adipose tissue

2. Breasts are usually nodular or granular prior to menses

3. Variation with breast augmentation— breasts feel fluid filled or firm throughout

Normal findings

Risk factors for breast cancer

1. Age > 50 2. Personal history of breast CA3. Mother, grandmother, or sister with breast

CA4. Menarche at an early age5. Menopause at advanced age6. Obesity7. Alcohol intake > 3 servings per day

1. American or European descent2. Urban dweller3. Estrogen therapy4. Nulliparous5. First birth after age 306. Higher education and socioeconomic status7. Atypical hyperplasia

Risk factors for breast cancer

Diagnostic techniques

1. Mammography

2. X- ray

3. Ultrasonography

4. Magnetic resonance imaging

Gerontological variations

1. Breast tissue atrophy

2. Decreased glandular tissue, resulting in granular feeling

3. Breasts become smaller, pendulous, and flatter

4. Ductal tissue becomes more palpable. Stringy feeling

Breast self-examination (BSE)

1. Performed once a month

2. Performed on a fixed date each month, or eight days after menses

3. Avoid completing during menstruation or ovulation

4. Use calendar for monthly reminder

5. Include significant other in examination process

Bed (B): supine position1. Use palmar surface of fingers2. Place right arm over head and palpate

right breast3. Move in concentric circles from the periphery

inward4. Squeeze the nipple to examine for discharge5. Use same procedure to check left breast

Breast self-examination (BSE)

Standing (S)o Repeat previous process in standing position

Examination (E)o Stand before mirror, arms at sideo Assess for symmetry, retractions, dimpling,

inverted nipples, or nipple deviationo Repeat with arms above head, and hands

pressed into hips

Breast self-examination (BSE)

Thank you