Breast and Axilla

Nursing 330

Governors State University

Shirley Comer

Relevant History

Pain lump Discharge Rash Swelling Trauma Surgery Self exam practices Tenderness

Breast Cancer can occur in men

Inspection

Size and symmetry– One breast may normally be slightly larger than the other

Skin– Smooth, non reddened– No bulges or dimpling– Fine blue veins normal as are striae

Nipple– Position and direction of nipple point– No discharge or retraction– Note lesions in nursing mothers

Screen for Retractions

Retraction is dimpling or puckering Ask pt to bend at the waist Ask to lift arms

– should move symmetrically Ask to put hands on hips

– observe position Ask to press hands together

– should move together

Inspect and Palpate the Axillae

Inspect skin Support patient’s arm Move fingers on a circular position through

axillae– Normally nodes not palpable– Nodes enlarge with local infection and breast cancer

with metastases

Breast Palpation

Patient should be supine (lying down) Place a small towel under shoulder on side to be

assessed Raise pt arm over her head Use pads of 1st three finger to palpate in a rotary

motion Assess entire breast using light, medium and then

deep palpation Cover entire breast- any pattern acceptable

Use the Middle of Your Fingers

Fingertips are too sensitive (all breasts are somewhat lumpy)Palm is too insensitiveMiddle portion of fingers is just right

Palpation cont

Nullaparus breasts feel firm and elastic Post parus breasts feel softer and looser Premenstrual tenderness is common r/t

increased progesterone levels Heat, Redness, and swelling in non lactating

breasts indicate inflammation

Palpate Nipple

Note any indurations or masses Gently squeeze nipple

– note any discharge ie color, consistency, odor

Except in pregnancy and lactation discharge is abnormal

Lactating women often have chaffed or sore nipples

Palpation Technique

Work your way around the breast in a clockwise fashion, using small circles of the hand as you go.Make sure the entire breast is felt.

Tail of Spence

If Lumps found then Assess:

Location Size Shape Consistency Moveable Tenderness Distinctness

Male Breasts

Normal male breasts have flat disk of undeveloped breast tissue beneath nipple

Gynecomastia is enlargement of male breast tissue– Can result from hormone, drug SE or disease

process– May occur normally in adolescence

Temporary Often unilateral

ACS Changes to Recommendationshttp://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp?sitearea=

Clinical Breast Exam– 20’s-30’s = every 3 years– After 40 = every year

Mammography– Every Year Beginning at age 40

MRI yearly for high risk women– BRAC gene– 1st degree relative

Monthly self breast exam= optional

Age Specific Considerations

Infants ‘witch’s Milk” may be secreted in 1st weeks of life– Breasts may be slightly enlarged

Adolescent female breast development occurs between 9 to 13 yo – can be delayed by poor nutrition or hormone

imbalance – lumps are usually benign cysts

Pregnant Female

Breasts and nipples Increase in size Vascularity may become more visible Striae may appear Nipples become darker and more erect Areola widen and contain small scattered

Montgomery’s glands May express thick yell colostrum /p 1st trimester

Lactating Female

Colostrum changes to milk approx 3rd day post partum

Breasts become engorged, reddened and shinny

May feel warm Nipples sore and may crack Frequent nursing is best treatment for

engorged and sore breasts

Aging Breast

May become pendulous an flattened Nipples may retract but should be easily pulled

outward Feels granular with prominent milk ducts Women over 50 have increased risk of breast

cancer Stress Self breast exam

Self Breast Exam

Instruct women to do monthly If premenapausal-do on last day on menstrual

flow If post menopausal or irregular menses-do on

the same day every month Men can also benefit from monthly self exam Report any abnormal findings or changes in

tissue to Doctor

Practice Exam Question

Your sister has fibrocystic disease of the breasts and consequently has many lumps in her breast. She mentions to you that she felt a new hard, unmovable lump this month. What would you advise her to do?

A. disregard it. It is probably another cyst B. check to see if it is bigger next month C. tell her doctor about it at her next yearly pap smear D. Make an appoint to see her doctor ASAP

Rationale

D is the correct answer. A malignant mass is frequently hard and unmovable. Early detection increases her treatment options.