HEALTH ASSESSMENT:Breasts

FOUR QUADRANTS OF THE BREAST

& Regional Lymphatics
CREATED BY: Michaela Arrofo BSN 1B
─
BREAST
1. MUSCLES
2. LIGAMENTS
3. GLANDULAR TISSUE
4. FATTY TISSUE
5. LYMPHATIC TISSUE
LYMPHATICS
● AXILLARY NODES
STRUCTURE AND FUNCTION ○ CENTRAL
SURFACE OF ANATOMY ○ PECTORAL(ANTERIOR)
○ SUBSCAPULAR(POSTERIOR)
1. Location of breasts on chest wall
○ LATERAL
2. Axillary tail of Spence-attracted with FATS
3. Nipple and areola

● DRAINAGE PATTERNS
DEVELOPMENTAL CARE
● ADOLESCENT
○ Puberty
● PREGNANT FEMALE
● AGING FEMALE
○ Menopause
● MALE BREAST
● CROSS-CULTURAL CARE
INTERNAL ANATOMY ○ Breast Cancer
● GLANDULAR TISSUE
○ Lobes,lobules and alveoli
SUBJECTIVE DATA-HEALTH HISTORY
○ Lactiferous ducts and sinuses QUESTIONS
● FIBROUS TISSUE
BREAST
○ Suspensory ligaments or Cooper’s
ligaments ● Pain
● ADIPOSE TISSUE-FAT DEPOSITS ● Lump
● Discharge
● Rash
● Swelling
● Trauma
● History of Breast Disease
● Surgery

● Self-care Behaviors
○ Breast self-examination
○ Last mammogram
● AXILLA
○ Tenderness,lump,or swelling
○ Rash
● Consistency
● Mobility
● Distinctness
● Nipple retraction
● Overlying skin
● Tenderness
● Lymphadenopathy
ABNORMAL FINDINGS SIGNS OF
RETRACTION AND INFLAMMATIONS
● Dimpling
● Fixation
● Edema (peau d’orange)
● Deviation in nipple pointing Nipple retraction

MONTH OF BREAST AWARENESS: OCTOBER

ADDITIONAL HISTORY FOR PREADOLESCENT
● Changes in Breast ABNORMAL FINDINGS BREAST LUMP
ADDITIONAL HISTORY FOR PREGNANT FEMALE ● Benign breast disease (formerly fibrocystic
● Enlargement of breasts breast disease)
● Plans to breastfeed ● Cancer
Additional history for menopausal woman ● Fibroadenoma
● Changes in breasts

OBJECTIVE DATA- PHYSICAL EXAM

Preparation
● Position
● Draping
Equipment
● Small pillow
● Ruler marked in centimeters
● Pamphlet or teaching aid for breast
self-examination
Breasts—Inspect
General appearance
Skin
● Lymphatic drainage areas
● Nipple
● Maneuvers to screen for retraction
Axillae—Inspect and Palpate
● Skin
● Palpation technique
● Lymph nodes
If a lump is present, note
● Location
● Size
● Shape

SCREEN FOR RETRACTION
● Ask patient to:
● •Lift arms slowly above head. Both Breast
Should move up symmetrically
● •Push hands into hip.
● •Push palms together
● •Lean forward
INSPECT AND PALPATE AXILLAE
● • While patient is sitting, lift and support
thermos patient’s muscles are relaxed
● • Use the right hand to palpate left axillae
● • Reach fingers high into axilla
● e• Move fingers firmly down in four directions
○ :– Down the chest wall, along the
anterior andposterior borders of
axillae and aroundtheinneraspect of
the arm
● • Move arm through
ROMtohaveaccesstoareas.
BREAST PALPATION
● Supine position with small pad/pillow
underside to be palpated
● Arm raised over head
● Use pads of fingers and make gentle rotary
movement on breast
● Use a pattern of concentric circles or
laterally,like spokes of a wheel.
● Palpate all areas of breast, clockwise fashion
● Make sure to include tail of Spence
BIMANUAL BREAST PALPATION
•For pendulous breasts
•Patient sitting, leaning forward
•Support inferior part of breast with one hand.
•Use other hand to palpate breast tissue against
supporting han
EXAMINATION OF NIPPLES
● Performed after breast palpation.
● •Palpate nipple, notinganyindurationsormass.
● •Use thumb and forefinger to apply gentle
pressure to note any discharge
CHARACTERISTICS OF BREAST LUMPS
● Location- use breast as clockface to describe
distance from nipple in centimeters(use
diagram to locate).
● Size- in centimeters
● Shape: oval, round, lobulated or indistinct
● Consistency: soft, firm, or hard
● Movable: freely movable, fixed to chest wall
● Tenderness
● Nipple: displaced, retracted, dimpled?

TEACHING (SELF BREAST EXAM ) BSE

● Assist patient to establish schedule•Regular
monthly exams
● •Majority of women never get breast cancer,
majority of lumps are benign
● •Early detection is important.
● •In non-invasive cancer, survival is close to
100%

SELF BREAST EXAM

● •Teaching positions:
– 1. Standing in front of mirror
2. In the shower – soap and water assist
palpation–
3. Supine
● •Keep teaching simple
● •Demonstrate to patient and use return
demonstration

THE MALE BREAST

● •Examination can be abbreviated but not
omitted.
● •Inspect the chest wall noting skin surface
and any lumps or swelling.
● •Palpate nipple area for lump or enlargement.
● •Normal male breast has a flat disc of
undeveloped breast tissue beneath the
nipple. Should be even with no nodules.
 OBJECTIVE DATA -PHYSICAL EXAM
Male breast
SUMMARY
● Gynecomastia ● Assessing the breast includes:
Developmental care ● •Take into account development aleve
● l•Remembering to assess both females and
● Infants and children males
● Adolescent ● •Inspecting and palpating breasts,
nipples,lymph nodes and axillary
● Pregnant female ● •Teaching BSE
● Lactating female
● Aging female
ABNORMAL FINDINGS -DISORDERS DURING
LACTATION
● Plugged duct
● Breast abscess
● Mastitis
ABNORMAL FINDINGS - MALE BREAST
● Gynecomastia
● Carcinoma

DOCUMENTATION: FEMALE
• S- Denies breast pain, lump,
discharge,rash,swelling, trauma. Denies past
history of breast disease or surgery. States
perform monthly breast exams.
• O- Inspection: Breasts symmetric. Skin Smooth
With even color. No dimpling or retraction
elicited. No nipple discharge. Nolesions.
• Palpation: Breast contour and consistency firm
and homogeneous. Nomassesortenderness.
No lymphadenopathy.
•A- Healthy breasts bilaterally with no S/S of
abnormalities
•P- Reinforce BSE(patient performsBSE monthly),
followupwithMDfor referral for mammogram