Professional Documents
Culture Documents
During a breast exam, the nurse will not check the mastectomy scar if a women has
a mastectomy within 2 years. FALSE
Annual mammograms are recommended for women 40 yrs and older. TRUE
Breast tenderness and lumpiness is common the week prior to menstruation. TRUE
Most malignancies occur in the upper outer quadrant of the breast. TRUE
Which of the following could be considered a risk factor for breast cancer for a
43-yr-old female?
Mother died of breast cancer
Menarche at age 11
50-yr-old sister currently has breast cancer
One child, a 7-yr-old son
A clear, milky white fluid expressed from the breast bud of a newborn infant is called
Witch’s milk
While examining the breast of 52-yr-old woman, examiner notes nipple discharge.
What diagnostic tests would be appropriate?
Cytologic examination of discharge
Yvonne had a mastectomy of right breast 2 yrs. ago. What statement assists
examiner with breast examination of this patient?
If malignancy recurs, it may be at the scar site.
While palpating the axilla, it is best to place the patient in a Sitting position with
the arms at the sides
What is the correct position in which to place the patient for breast palpation?
Supine with arms over the head and small pillow under the shoulder of the
side being assessed
PREGNANT WOMEN
- lactiferous ducts proliferate and alveoli increase extensively in size and
number, which may cause breasts
to enlarge 2 to 3 prepregnancy size
- increase in glandular tissue displaces connective tissue so that tissue
becomes softer and looser
- areolae become more deeply pigmented and diameter increases
- nipples become more prominent, darker, and more erectile
- mammary vascularizaion increases, causing veins to engorge and become
visible as blue network beneath
skin surface
LACTATING WOMEN
- small amts of colostrum secrete from breasts
- colostrum contains more protein and minerals than does mature milk
and antibodies and other host
resistance factors
- replacing colostrum milk production begins 2 to 4 days after delivery in
response to surging prolactin levels,
declining estrogen levels, and stimulation of sucking
- breasts may become full and tense
- combined with tissue edema, a delay in effective ejection reflexes,
produces breast engorgement
- at termination of lactation, involution occurs over a periods of about 3 mos
- breast size decreases but rarely return to prelactation size
OLDER ADULTS
- after menopause, glandular tissue continues to atrophy gradually and is
replaced by fat deposited in
breasts
- breasts tend to hang more loosely
- nipples become smaller, flatter, and lose some erectile ability
- skin may take on relatively dry, thin texture
- loss of axillary hair may occur
C. FAMILY HISTORY
- breast cancer (relatives, type, age of occurrence, treatment and
results), other breast disease in
female and male relatives
1. Steps:
- stand before mirror, inspect for anything unusual (discharge,
puckering, dimpling, scaling of
skin)
- clasp hands behind head and press hands forward
- press hands firmly on hips and bow slightly, pulling shoulders
and elbows forward
- raise left arm, use 3 or 4 fingers of right hand to explore left
breast firmly
- begin at outer edge, press flat part of fingers in small
circles, moving slowly around
breast
- gradually work toward nipple, covering entire breast
paying special attention to
area between breast and armpit
- gently squeeze nipple looking for discharge
- repeat exam on right breast
B. INSPECTION
1. Breast - patient in sitting position with arms hanging loosely
- inspect for size, symmetry, contour, skin color and texture,
venous patterns, and lesions
- perform this part of procedure on males and females
- inspect lower and lateral aspects for changes in color or texture
of skin
- often one breast is somewhat smaller than the other
- some men have breasts with convex shape
- skin texture should appear smooth and contour should be
uninterrupted
- retractions and dimpling signify contraction of fibrotic
tissue occurring with
carcinoma
B. PALPATION
1. Breast - use finger pads because they are more sensitive than
fingertips
- essential to include tail of Spence, because most malignancies
occur in upper outer
quadrant of breast
B. ADOLESCENTS
- breast tissue of adolescent female feels homogenous, dense, firm, and
elastic
- malignancy is rare
- start self-exam early can establish healthy habit
- many males at puberty have transient or bilateral subareolar masses
- will most likely disappear within a year
- seldom enlarge to point of cosmetic surgery
- many experience gynecomastia, unusual and unexpected enlargement
that is readily noticeable
- temporary, benign, and resolves spontaneously
- if extreme, can be corrected surgically for psychologic or
cosmetic reasons
- can be associated with use of either illicit or prescription
drugs
C. PREGNANT WOMEN
- most changes become obvious during 1st trimester
- many experience sensation of fullness with tingling, tenderness, and
bilateral increase in size
- nipples enlarge and are more erectile
- later in pregnancy, nipples sometimes become flattened or
inverted
- areola broaden and darken
- Montgomery tubercles may appear
- palpation reveals generalized coarse nodularity (feel lobular because
of hypertrophy of mammary
alveoli)
- vascular spiders may develop on upper chest, arms, back, and face
- striae may be evident as a result of stretching
D. LACTATING WOMEN
- full breasts, which are firm, dense, and slightly enlarged, may become
engorged
- engorged breasts feel hard and warm and are enlarged, shiny,
and painful
- clogged milk ducts are relatively common
- may result from either inadequate emptying of breast or
brassiere that is too tight
- frequent nursing and/or expression of milk, along with local
application of heat, will help
open
- examine nipples for signs of irritation (redness and tenderness) and for
blisters or petechie
(precursors of overt cracking)
- after pregnancy, areolae and nipples tend to retain darker color, and
breasts become less firm than
prepregnant state
E. OLDER ADULTS
- postmenopausal breast may appear flattened, elongated, and
suspended more loosely from chest
wall
- finer, granular feel on palpation
- inframmary ridge thickens and can be felt more easily
- nipples become smaller and flatter
MALIGNANT BREAST TUMORS – peak incidence between ages 40 and 60 yrs, with 2/3
occurring in women under 65
- metastases occur through lymph and vascular systems
- mass or thickening in breast, marked symmetry of breasts, prominent
unilateral veins, discolorations, peau
d’orange, ulcerations, dimpling, puckering or retraction of skin or areola,
fixed inversion or deviation
in position of nipple, crusting or erosion of nipple or areola, change in
surface characteristics
ADULT GYNECOMASTIA – smooth, firm, mobile, tender disk of breast tissue located
behind areola in males
- may be unilateral or bilateral
- can be caused by hormone imbalance, by testicular, pituitary, or hormone-
secreting tumors, liver failure, or
by antihypertensive medications or those containing estrogens or
steroids