Assessing the breast and lymphatic system

Assessing the breast and lymphatic system

1. ASSESSING THE BREASTS AND LYMPHATIC SYSTEM

2. The breasts are paired mammary glands that lie over the muscles of the anterior chest wall, anterior to the pectoralis major and serratus anterior muscles. Depending on their size and shape, the breasts extend vertically from the second to the sixth rib and horizontally from the sternum to the mid-axillary line FUNCTION: the female breast is an accessory reproductive organ with two functions: to produce and store milk that provides nourishment for newborns and to aid in sexual stimulation.. The male breasts have no functional capability

3. the breasts are divided into four quadrants by drawing horizontal and vertical imaginary lines that intersect at the nipple. The upper outer quadrant, which extends into the axillary area, is referred to as the tail of Spence. Most breast tumors occur in this quadrant lymph nodes are present in both male and female breasts. These structures drain lymph from the breasts to filter out microorganisms and return water and protein to the blood.

4. EXTERNAL BREAST ANATOMY The nipple, which is located in the center of the breast contains the tiny openings of the lactiferous ducts through which milk passes . The areola surrounds the nipple (generally 1 to 2 cm radius) and contains elevated sebaceous glands (Montgomery glands) that secrete a protective lipid substance during lactation. Hair follicles commonly appear around the areola

5. INTERNAL BREAST ANATOMY Female breasts consist of three types of tissue: glandular, fibrous, and fatty (adipose) Glandular tissue constitutes the functional part of the breast, allowing for milk production. Fatty tissue a fat provides most of the substance to the breast, determining the size and shape of the breasts. Fibrous tissue holds the breast tissue in place Breasts have mammary glands. These modified sweat glands are involved in lactation, or the production of milk. These glands consist of sections called lobes, and there are about 15-20 of these per breast, arranged in a circle like the petals of a flower. Each lobe consists of many smaller lobules, which are glands that produce milk. Lobules are composed of numerous tiny, hollow sacs, called alveoli, which drain into a single lactiferous duct. Lactiferous ducts converge at the nipple. Just before these ducts enter the nipple, they are dilated at the lactiferous sinus. Production and secretion of milk is regulated by the hormones prolactin and oxytocin, which are secreted by the pituitary gland.

6. LYMPH NODES The major axillary lymph nodes consist of the anterior (pectoral), posterior (subscapular), lateral (brachial), and central( miSupraclavicd -axillary) nodes ular and intraclavicular anterior chest wall and breasts. The posterior chest wall and part of the arms are drained by the posterior nodes. The lateral nodes drain most of the arms, and the central nodes receive drainage from the anterior, posterior, and lateral lymph nodes. A small proportion of the lymph also flows into the infraclavicular or supraclavicular lymph nodes or deeper into nodes within the chest or abdomen.

7. COLLECTING SUBJECTIVE DATA: THE NURSING HEALTH HISTORY CURRENT SYMPTOMS Changes in breast (lumps, swelling, redness, dimpling, firmness, discharge? Do you experience any pain your breast? We use the COLDSPA Past history Previous problems with breasts ( treatment and surgery) How old were you when you began to menstruate? Have you experienced menopause? Have you given birth to any children? At what age did you have your first child? When was the first and last day of your menstrual cycle? Family History of breast cancer

8. Lifestyle and Health Practices Are you taking any hormones, contraceptives, or antipsychotic agent What is your typical daily diet? How much alcohol do you consume each day? How often do you use tobacco each day Do you engage in any type of regular exercise? If so, what type of bra do you wear when you exercise? Do you examine your own breasts? Have you ever had your breasts examined by a health care provider? When was your last examination? Have you ever had a mammogram? If so, when was your last one?

9. . Check size, shape and color. Look for any signs of fluid coming out of one or both nipples Use your middle finger pads and move them in a circular motion covering the entire breast from top to bottom, side to side- from your collar bone to the top of your abdomen and from your armpit to your cleavage.

10. COLLECTING OBJECTIVE DATA: PHYSICAL EXAMINATION Equipment • Centimeter ruler • Small pillow • Gloves • Client handout for BSE • Slide for specimen INSPECTION 1. Inspect size and symmetry. Have the client disrobe and sit with arms hanging freely Explain what you are observing to help ease client anxiety. 2. Inspect size and symmetry. 2. Inspect color and texture. 3. Inspect superficial venous pattern Inspect the areolas Inspect the nipples

11. Inspect for retraction and dimpling. The client’s breasts should rise symmetrically, with no sign of dimpling or retraction. Breasts should hang freely and symmetrically The best time to do a monthly breast self-exam is  about 3 to 5 days after your period starts . Do it at the same time every month. Your breasts are not as tender or lumpy at this time in your monthly cycle.

12. PALPATION Palpate texture and elasticity- Palpation reveals smooth, firm, elastic tissue. 2. Palpate for tenderness and temperature 3. Palpate for masses- Palpate for masses. Note location, size in centimeters, shape, mobility, consistency, and tenderness.