NR 304 EXAM 3 STUDY GUIDE
Breast and Axillae
Structure and Function
-Purpose: production of milk and sexual pleasure
-Cooper’s Ligaments: “coopers droppers” breast stretch as you age (ligaments lengthen
and stretch)
-Four quadrants of the breast (face of clock)
-Tail of spence: up by the axillary, check for lumps
-Where breast cancer is usually found
-Palpate all the lymph nodes
-Central (axillary)
-Pectoral (anterior)
-Subscapular (posterior)
-Lateral (brachial)
Breast History
-Is it cyclic? Does it occur around the same time? Example: every time a woman gets her period
she gets breast pain.
-Caffeine contribute to pain
-Skin Rash: where did it start? From the nipple out? Or the skin towards the nipple?
Paget’s Disease: nipple is red, scaly, and itchy, spreading off of nipple
Galactorrhea: discharge
-Yellow discharge: clostridium (normal for pregnant)
-Bloody nipple discharge: cancer
-Grayish discharge: clogged duct from milk
Development: Childhood
-Newborns: breasts may be enlarged at birth due to mom’s hormones (witch’s milk)
-Adolescence: tanner 2-5 about 3 years
-Stage 1) preadolescent stage: before age 10, nipple small, slightly raised
-Stage 2) Breast bud stages: after age 10, nipple and breast form small mound
-Stage 3) Menarche begins (first period), breast bud will enlarge
-Stage 4) Late adolescent stage (14-17 years)
Pregnancy
Non-pregnant breast
-3-4 days before period: full, tight, heavy, sore
-4-7 days after period: least full, least nodular
Pregnant breast
-Ductal system expansion, secretory alveoli
-Nipples/areola large and dark, venous pattern
, -Colostrum (4th month) thick yellow protein rich
Cultural Considerations
-African-American girls begin puberty 1-1.5 years earlier than Caucasian
-Menses: African-American girls 8.87 years compared to 10 years for Caucasian
-Puberty began before 8 years highest in Hispanics
Breast Exam: Inspection
-Skin: color, texture, temperature, appearance, dimpling, nipple retraction
-One breast usually bigger than the other
-Supernumerary Nipples: normal variant
Supernumerary Nipples
-Normal variant along tract of mammary ridge
-3rd Nipple
Abnormalities
Peau cl’orange: porous, orange looking, big sign of breast cancer
Gynecomastia: enlargement of breasts (male) usually due to testosterone decrease from cirrhosis,
testicular tumor, DM, pituitary tumor, alcoholism, obesity
Risk Factors for Breast CA
-50 years or older
-BRCA 1 and 2 genes
-First degree relative
-Menstruation less than 12 yr
, -Menopause greater than 55 yr
-Never breast feed
-Nulliparity (never having a child) or first child greater than 30
Breast Abnormalities
Fibrocystic: (benign)
-20-35 “water balloons” that change size/shape with monthly hormones, can be painful
-Wear supportive bra
-Decrease caffeine, low fat diet, decrease smoking
Fibroadenoma (benign)
-Very common “lump” found in younger women 18-25, rapid growing “lump” firm,
smooth, painless, moveable-frequent biopsies
Mammary Duct Ectasia (benign)
-Ducts get wide and full of old cells, dried colostrum-pain, hard lump, with pasty colored
discharge, often nipple retraction
Cancer
-Pucker, pull, skin change, discharge
-Can be contained or spreading
Intraductal Papilloma
-Starts in duct and moves outward
-Blood tinged discharge
Paget’s
-Skin changes with scaling, redness, pain, nipple changes, from inside to out, length of
breast, malignant
Female Reproductive System
External Genitalia
-Mons Pubis: adipose tissue covering the symphysis (hair in mature female), protects
reproductive structures
-Clitoris: small, elongated mound of erectile tissue
-Labia: dual set of lip-like structures on either side
-Labia Majora: cover external genitalia
-Labia Minora: overlie the vaginal and urethral openings
Skene’s Gland: paraurethal gland
-Located posterior to urethral orifice
-Has higher pH value to decrease bacteria, cleans urethra
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