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NUR 245 Pre-Lab Week 8 Notes
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- NUR 245
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Nursing 245 - Pre-Lab Week 8Sovanny Lim
October 22, 2020
Chapter 18
Study Guide
1. Do you have any breast pain, any concerns? If so, what is it brought on by?
Are there any lumps, thickening, change in the skin? If so, when did you notice this
change?
Is there any discharge from the nipple? If so, when did it start, what color is it, what is the
consistency, is there an odor?
Have you had any surgery on your breast?
Do you have a history of breast disease? If so, what type was it, how old were you when
you were diagnosed, when were you diagnosed, how was it treated? How many years in
remission are you?
Do you have a family history of breast disease? How old were those affected when he/she
found out?
Do you do self breast exams? How often?
Have you had a mammogram? How often do you need to repeat it?
2. The breast is located between the 2nd and 6th rib. The Tail of Spence is located in the
axillary. It is composed of glandular tissue, fibrous tissue, adipose tissue. It is broken up
into four quadrants. The upper, outer quadrant is where most breast tumors arise.
3. Stage 1 is pre-adolescent. There is only a small, elevated nipple.
Stage 2 is the breast bud stage. There is a small mound of breast, the nipple develops, the
areola widens.
Stage 3 is when the breast and areola enlarge. The nipple is flush with the breast surface.
Stage 4 is when the areola and nipple form a secondary mound over the breast.
Stage 5 is mature. Only the nipple protrudes, the areola is flush with breast contour.
4. With the breast exam, you should start with asking the patient questions to gather
subjective information. This includes asking if there is breast pain, any lumps that were
noticed, any discharge from the nipple, rash on the breast skin, swelling, trauma, history
of breast disease, surgery, radiation, medications. This also includes asking if there is any
axillary tenderness, lumps, swelling or rash.
Next you will inspect and palpate to gather objective information. Inspection allows you
to see the general appearance of the breast, the skin, any lymphatic drainage areas,
nipple, test for skin retraction. You will then palpate the breast. You will also inspect the
axilla and palpate it as well.
- Inspect breasts as the patient sits, raises arms overhead (tests for skin retraction),
pushes hands on hips (tests for a dimple), leans forward (fixation to chest wall)
- General appearance- symmetry
- Skin- bulging, edema, dilated blood vessels
- Lymphatic drainage- bulging, edema, discoloration
- Nipple- deviation, retraction, discharge
- Inspect supraclavicular, infraclavicular areas
- Palpate axillae and regional lymph nodes
, - Have the patient lay supine, palpate the breast tissue, Tail of Spence, nipples, areola
5. When teaching about breast self-examination, educate about the fact that early detection
of breast cancer is very important, demonstrate correct techniques and expected findings,
how to perform it (in front of a mirror, disrobed), when to palpate (when standing and
lying down, right after menstrual period.
6. The significance of a supernumerary nipple or breast is that there is a normal and
common variation- it is an extra nipple along the embryonic or milk line on the thorax or
abdomen. It is a congenital finding with no associated glandular tissue with a tiny areola
and nipple.
7. The difference between male and female examination procedures and findings is that
male exams can be abbreviated, able to combine it with the anterior thorax. A female’s
examination is much longer and more complex.
8. Benign breast disease: multiple tender masses that occur with numerous symptoms and
physical findings- swelling and tenderness, nodularity, dominant lumps, nipple discharge,
infections and inflammations
Abscess: rare complication of generalized infection, pocket of pus that feels hard, looks
red, quite tender accumulates in one local area
Acute mastitis: an inflammatory mass before abscess formation, usually occurs in single
quadrant, area is red, swollen, tender, very hot and hard, forming outward from areola
upper edge in right breast, may occur during first 4 months of lactation from infection or
from stasis from plugged duct
Fibroadenoma: a benign mass/ solitary non-tender mass that is solid, firm, rubbery,
elastic/ round, oval, lobulated/ 1 to 5 cm
Cancer: bloody nipple discharge that is unilateral and from a single duct requires further
investigation
Paget disease: early lesion has unilateral, clear yellow discharge and dry, scaling crusts,
friable at nipple apex, spreads outward to areola with erythematous halo on areola and
crusted eczematous, retracted nipple
9. The characteristics to consider when a mass is noted in the breast are location, size, shape,
consistency, moveable, distinctness, nipple, skin, tenderness, lymphadenopathy.
10. Gynecomastia is the benign enlargement of male breast that occurs when estrogen
concentration exceeds testosterone levels.
11. A screening mammography and clinical breast examination for the diagnosis of breast
lesions starting at the age of 40, can discover small, potentially curable breast cancers.
12. The high risk factors that increase the usual risk for breast cancer are age, biopsy-
confirmed atypical hyperplasia, certain inherited genetic mutations for breast cancer,
ductal and lobular carcinoma in situ, mammographically dense breasts, persona history
of early onset breast cancer, two or more first degree relatives with breast cancer
diagnosed at an early age.
The moderate risk factors that increase the usual risk for breast cancer are personal
history of breast cancer, high endogenous estrogen or testosterone levels, high dose
radiation to chest, one first-degree relative with breast cancer.
13. Image 1
a. Lactiferous duct
b. Lactiferous sinus
c. Lobule
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