A&P
State what the small bumps are called on the surface of the areola.
Montgomery glands
FYI they secrete a lipid substance to protect the nipple and areola integrity during breastfeeding.
State two (2) questions that correlate with present health conditions
Any pain or tenderness in breasts or axillae area?
Notice any changes in the appearance of breasts, nipples or axillae?
Seen or felt swelling, lumps, or rashes?
Had any nipple discharge?
Female at birth - are you still menstruating?
Painful or swollen lymph nodes?
State the expected breast findings that correlate with skin color and condition.
Skin should be smooth and similar color to surrounding skin.
Which client is at an increased risk for self-esteem disturbance? (Select all that apply).
A. Client with average breast size.
B. Client with a mastectomy.
C. Client with symmetric breasts.
D. Client with bruising at the axilla from abuse.
E. Client with mastitis.
B, D, E
Client with above or below average size or asymmetric breasts would be at increase risk.
There are four (4) main areas where superficial nodes can be palpated. State one of these areas.
Cervical
Axillary
Epitrochlear
Inguinal
State two (2) questions that correlate with past health conditions
Ever have any breast disease?
Any breast trauma, surgery, or biopsy?
Routine examination of the breasts by a healthcare provider?
Perform own self-exams of your breast?
State one expected variation of breast skin color and condition.
Striae, pale linear marks "stretch marks".
Skin friction may be noted as inflammation or excoriation for clients with large breasts.
The nurse taught a client about self-breast exam. The client is observing the breasts for shape, size, and contour during various arm movements. Which statement indicates an expected finding?
A. Contour should be smooth and unchanged when arms change position.
B. Breasts should have significant differences.
C. The contour should change position when arms change position.
D. Bulging areas are a normal finding.
A. Contour should be smooth and unchanged when arms change position.
B, C, D are all unexpected findings.
State one (1) organ that works along with the lymphatic system.
Tonsils: entrance to GI and respiratory tract
Thymus: between aorta & sternum. Will shrink as we age. Produces T lymphocytes.
Spleen: produces antibodies, filters pathogens.
Bone marrow: produces B lymphocytes.
State one (1) question that correlate with family history.
Any of your family members had breast cancer?
Any family member with lymphatic cancers or diseases?
State an expected finding for the areolas and nipples.
Color can range from pink to black based upon hormones and ethnicity.
Symmetrical bilaterally, positioned along the same plan with orientation in the same direction.
Areola should be round or oval, that is smooth and intact, may have visible Montgomery glands
Nipple: protrudes or flat or inverted if present since puberty.
The nurse taught a client about self-breast exam. The client is observing the areolas and nipples. Which statement indicates an expected variation?
A. Change in nipple presentation.
B. Dry scaling rash on the areola and/or nipple.
C. Supernumerary nipple.
D. Discharge and not lactating.
C. Supernumerary nipple.
This is the "extra" nipple that may appear pink, brown and appear along the embryonic milk line anywhere from breast to groin area. Can be mistaken for moles.
A, B, D are unexpected findings - think cancer. D may occur if an infection is present.
State the function for the male breast.
Nothing.
Female = primary function is lactation.
State the best time to perform a breast self-exam for a menstruating client.
4-7 days after the start of menstrual cycle.
State an expected finding when a lymph node is palpable.
non-painful, oval shape, smooth texture, with well-defined borders, and moves slightly when palpated.
Found after having an illness. Can be palpated up-to 2-4 weeks.
When assessing the breasts of a 60-year-old female, the nurse palpates the breasts and notes breast tissue that is pendulous with loss of elasticity. What action would the nurse take at this time?
A. Document this as a normal finding.
B. Notify the healthcare provider for further investigation.
C. Prepare the client for a mammography since this indicates fibrocystic breast disease.
D. Assess for Paget's disease.
A. Document this as a normal finding.
Pendulous breast tissue is a normal change with age and is a benign finding.
Fibrocystic breast presents as a nodular, soft, movable lesion.
Paget's disease is a malignancy that starts as a scaly, crusty lesion on the nipple.
State one (1) function of the lymphatic system.
Detect and eliminate micro-organisms from the body.
Absorb lipids from the small intestine during digestion.
Reabsorb fluid from interstitial tissues.
FYI: edema results when there is removal or damage to lymph d/t the fluid shift and leakage into the tissue.
State two risk factors for breast cancer.
Diethylstilbestrol (DES) ingestion or exposure
Female
Increased age
Immediate family history: breast, ovarian
Menstruation before age 12, menopause after 55
Caucasian race
Sedentary lifestyle
Obesity
Alcohol consumption
Oral contraceptives or hormone replacement therapy (estrogen & progesterone)
Pregnancy after 30, nulliparity, never having a full-term pregnancy, or not breastfeeding
State an unexpected finding of the breast skin color and condition
Peau d'orange: associated with breast cancer, causes edema that dilates hair follicles. Looks like an orange.
Infection: inflamed, warm, edematous breast
Thick rough skin
Unilateral dilated veins or unilateral rash
dimpling
Inflammation
Edema
Before assessing a female client's breasts for dimpling the nurse will position the client in which best position?
A. Supine
B. Sitting with hands over the head
C. Sitting with hands on the hips
D. Lateral
C. Sitting with hands on the hips, this contracts the pectoralis muscle, allowing one to observe for dimpling.
Supine will distribute the tissue evenly.
Lifting hands over head assists in assessing for fibrosis since a breast will lag behind.
Lateral: lying on left or right, better for a surgical client or colonoscopy, not breast exam.