Breasts and Regional Lymphatics

1
Breasts and Regional Lymphatics

• Chapter 17

2

• Structure and Function
• Subjective DataHealth History Questions
• Objective DataPhysical Exam
• Abnormal Findings

3
Structure and Function

• Surface anatomy
• Location of breasts on chest wall
• Axillary tail of Spence
• Nipple and areola

4
Structure and Function (cont.)

• Internal anatomy
• Glandular tissue
• Lobes, lobules, and alveoli
• Lactiferous ducts and sinuses
• Fibrous tissue
• Suspensory ligaments or Coopers ligaments
• Adipose tissue
• Four quadrants of the breast

5
Structure and Function(cont.)

• Lymphatics
• Axillary nodes
• Central
• Pectoral (anterior)
• Subscapular (posterior)
• Lateral
• Drainage patterns

6
Structure and Function (cont.)

• Developmental care
• Adolescent
• Puberty
• Pregnant female
• Aging female
• Menopause
• Male breast

• Cross-cultural care
• Breast cancer

7
Subjective DataHealth History Questions

• Breast
• Pain
• Lump
• Discharge
• Rash
• Swelling
• Trauma

8
Subjective DataHealth History Questions (cont.)

• History of breast disease
• Surgery
• Self-care behaviors
• Breast self-examination
• Last mammogram
• Axilla
• Tenderness, lump, or swelling
• Rash

9
Subjective DataHealth History Questions (cont.)

• Additional history for preadolescent
• Changes in breasts
• Other changes
• Additional history for pregnant female
• Enlargement of breasts
• Plans to breastfeed
• Additional history for menopausal woman
• Changes in breasts

10
Objective DataPhysical Exam

• Preparation
• Position
• Draping
• Equipment
• Small pillow
• Ruler marked in centimeters
• Pamphlet or teaching aid for breast
  self-examination

11
Objective DataPhysical Exam (cont.)

• BreastsInspect
• General appearance
• Skin
• Lymphatic drainage areas
• Nipple
• Maneuvers to screen for retraction
• AxillaeInspect and Palpate
• Skin
• Palpation technique
• Lymph nodes

12
Objective DataPhysical Exam (cont.)

• If a lump is present, note
• Location
• Size
• Shape
• Consistency
• Mobility
• Distinctness
• Nipple retraction
• Overlying skin
• Tenderness
• Lymphadenopathy

13
Teach Breast Self-Examination

• Schedule for self-exam
• Correct technique
• Return demonstration

14
Objective DataPhysical Exam (cont.)

• Male breast
• Gynecomastia
• Developmental care
• Infants and children
• Adolescent
• Pregnant female
• Lactating female
• Aging female

15
Abnormal Findings Signs of Retraction and
Inflammation

• Dimpling
• Fixation
• Edema (peau dorange)
• Deviation in nipple pointing
• Nipple retraction

16
Abnormal Findings (cont.) Breast Lump

• Benign breast disease (formerly
  fibrocysticbreast disease)
• Cancer
• Fibroadenoma

17
Abnormal Findings for Advanced PracticeAbnormal
Nipple Discharge

• Mammary duct ectasia
• Carcinoma
• Intraductal papilloma
• Pagets disease (intraductal carcinoma)

18
Abnormal Findings (cont.)Disorders During
Lactation

• Plugged duct
• Breast abscess
• Mastitis

19
Abnormal Findings (cont.)Male Breast

• Gynecomastia
• Carcinoma