ASSESSING THE BREASTS

NUR211 Kathleen Hancock

Assessing the Breasts

Obtain a breast history. Perform a breast physical assessment. Document breast assessment findings. Differentiate between normal and abnormal findings.

Breast Composition
3 types of tissue:
*Glandular
*Fibrous *Adipose

Structures
Lobes and lobules Lactiferous ducts and sinuses Areola Montgomerys glands

Structures
Nipple Coopers ligament Pectoralis major and serratus anterior muscles

Functions
What are the functions of Lobes & lobules: Contain alveoli cells that produce milk Lactiferous ducts & sinuses: Carry and store milk Areola: Dark tissue surrounding nipple
(Continued)

Functions
What are the functions of Montgomerys glands: Sebaceous gland Nipple: Nursing and sexual stimulation Coopers Ligament: Ligament attached to chest wall muscles that supports breasts
(Continued)

Functions
What are the functions of Pectoralis major & serratus anterior muscles: Breast overlies these muscles Lymph nodes: Drain breast, chest, and arms

Breast Health:
Cancer Prevention
Self Breast Exam (SBE)
Every month

Mammogram
After age 40 every year More frequent if personal or family history

Breast Exam by nurse or doctor every year

Developmental Variations
What developmental breast variations might be seen with: Children Pregnant clients Older adults

History
What can the history tell you about the breast? Biographical data Current health status Past health history Family history Review of systems Psychosocial history

Symptoms
What symptoms signal a problem with the breasts? Breast lump or mass Pain or tenderness Nipple discharge

Physical Assessment
Anatomical landmarks: quadrants of the breast, include Tail of Spence

(Continued)

Inspection
Breasts: size, shape, symmetry, color, lesions, venous pattern, dimpling, or retraction
Nipple and areola: nipple position and direction; discharge Axillae: color, lesions, rashes

Physical Exam Inspection

Position: sitting, hands on hips, hands over head, leaning forward Tools: small pillow or towel, ruler, gloves, slide, and culture slide.

Sitting, arms at sides

Arms overhead

Arms pressing on hips

Leaning forward

Palpation
Lymph nodes: axillary, clavicular while sitting Breasts: consistency, masses, tenderness in supine position
Nipple: elasticity, masses, tenderness, discharge

Supraclavicular Nodes

Infraclavicular Nodes

Axillary Nodes

Palpation Vertical Strip Method Preferred

Approach: supine

with pillow or towel under shoulder Pattern (vertical, wedge, or circular) light, medium, and deep

Supine with shoulder support Use pads of fingers of

dominant hand

Strip Method of Palpation

Cover all of breast Use 3 middle finger pads, not tips Use sliding motion Overlapping dime size circles 3 pressure levels: light, medium, deep Include nipple and areola

Large Breasts
Bimanual palpation to adequately examine all areas Often have an inframammary ridge

Male Breast
Inspection Palpation
Lymph nodes while sitting Breast while sitting or if large while lying down

Male Breast Enlargement:

Gynecomastia

Characteristics of Masses
Note: Location Size Mobility Temperature
Shape/Borders
Tenderness Consistency Redness

Example: Pertinent Physical Findings

Right breast larger than left No dimpling, retraction Small, pea size (0.5cm), movable, rubbery, smooth-edged lesion in right breast at 2 oclock in RUQ No palpable nodes