Assessment of Breast and Axiila .pptx

Nursing practice

1. Salale University College of Health Sciences Department of Adult Health Nursing Presentation On : Assessment of Breast and Ax i l a Submitted to Taddala Assistant Professor June 2/06/ 2023 Fiche

2. Learning out come At the end of this Lesson the study participants will be able to: Describe the anatomy & physiology of the breasts and a x i l l a ( regional lymphatics ) , including age related variations. Demonstrate assessment techniques for the evaluation of the breasts and Axilla ( lymphatics ) . Perform a breast and axilla hysical assessment. Differentiate between normal and abnormal findings. Discuss methods of teaching breast self-examination to patients. Understand normal breast change during developmental care

3. B r e a s t Breasts are paired mammary glands located within superficial fascia of anterior chest wall The female breast lies against the anterior thoracic wall, extending from the clavicle and 2nd rib down to the 6th rib, and from the sternum across to the midaxillary line. The breast is made up of three types of tissue: Glandular: Also called lobules, glandular tissue produces milk. Fatty: This tissue determines breast size Connective or fibrous: This tissue holds glandular and fatty breast tissue in place. Male breast has no lobes and located in 4th intercostal space in mid clavicle .

4. Breast Anatomy There are many different parts o f female breast anatomy, including: Lobes and lobules : Composed of 15-25 radially arranged lobes of parenchyma and Contain alveoli cells that produce milk Milk (mammary) ducts: These small tubes, or ducts, carry milk from glandular tissue (lobules) to nipples. Nipples: The nipple is in the center of the areola.

5. Breast Anatomy Areolae: Dark tissue surrounding nipple and have glands called Montgomery’s glands that secrete a lubricating oil. Blood vessels: circulate blood throughout the breasts, chest and body. Nerves: Nipples have hundreds of nerve endings, which makes them extremely sensitive to touch and arousal. Limph vessel-are connected to lymph nodes under the arms that help fight infections.

6. Breast anatomy

7. Breast anatomy Divided into four quadrants by vertical and horizontal lines intersecting at nipple.

8. Breast physiology Breasts are part of the female and male sexual anatomy. For females, breasts are both functional (for breastfeeding) and sexual (bringing pleasure). Male breasts don’t have a function. Breasts size change dramatically during pregnancy and lactation in response to luteal and placental hormones: Nipples enlarged , Visible veins , Soreness , tenderness Enlarged, darker Montgomery tuberclles and colostrum Breast changes during lactation in response to luteal hormones: Increase size , Increase weight Male breast undergoes little development after birth; gland remains rudimentary.

9. Axilla A pyramid-shaped space between the upper part of the arm and the side of the chest The axillary walls are used as landmarks by surgeons to prevent damage to the neurovascular structures within the axilla during surgery. The overall 3D shape of the axilla looks slightly like a pyramid. It consists of four sides, an open apex and base: Apex – also known as the axillary inlet, it is formed by lateral border of the first rib, superior border of scapula, and the posterior border of the clavicle. Medially - serratus anterior, thoracic wall Laterally - intertubercular sulcus of the humerus Anteriorly - pectoralis major and minor Posteriorly - subscapularis, latissimus dorsi, teres major muscles

10. AXILLA The contents of the axilla region include: Muscles - coracobrachialis, pectoralis minor, and the biceps brachii Blood vessels - axillary artery and vein Nerves - brachial plexus Lymphatics - axillary lymph nodes (pectoral, subscapular, lateral, central, infraclavicular groups)

11. Clinical Examination Include : Explain to your patient Patient’s permission Privacy palpation of both breasts, armpits and root of the neck D o n e before biopsy by Semi-recumbent position (45°) , supine, sitting Expose upper half of the patient, both breasts exposed Arms by the sides educating women on breast self-examination and awareness, particularly on breast lumps.

12. Physical Assessment of Breast and Axilla Involve : B reast history Inspection Palpation Documentation

13. B r e a s t History Detailed history analysis of : Biographical data ( Age , Gender , Race ) Current health status ( c h a n g e in size , Pain , a x i l l a r y and breast tenderness , , skin lesion , redness , nipple inversion , trauma , t h i c k i n i n g , discharge ) History of BSE History of hospitalization and medication

14. Breast History History of mammogram History of menstrual , pregnancy, lactation, family, previous breast , problems History of Breast Disease/Surgery

15. History of pain Site , Duration , Onset and severity Relationship to menstrual cycle (cyclical or non-cyclical) Aggravating factors and Relieving factors

16. Menstrual History Age of menarche Age at menopause : early menarche (<12 year), late menopause (>55 year)- increases risk for carcinoma Last menstrual period Regularity of menstrual cycle Breast changes during menstrual cycle

17. History of nipple discharge When did you notice discharge from nipple? Ever noticed before? One or both nipples? Describe discharge: Color? , Thick or thin? , Odor? Occur spontaneously ?

18. Hx o of Breast and xillary Lumps When did you first notice lumps or tenderness under your arms? Where? One or both arms? Come and go, or constant? Has it gotten worse? Shave underarms? What have you done to treat this?

19. Hx of pregnancy Age at 1st pregnancy : - younger age (<18) is protective - >30 years- increased risk Number of pregnancy- protective Lactational history- protective

20. Family Hx At least two generations Breast , gynecologic, colon, prostate, gastric, or pancreatic cancer Age at diagnosis of these tumours.

21. Past Medical / Surgical Hx Breast problem Mammogram Breast biopsy Obesity (BMI >25) - risk factor Exposure to radiation (face, chest)- risk factor Other medical /surgical history

22. Hx of Breast and Axilla Swelling lump When did you first notice lump in your breast? Where is lump? Is lump always present, or does it come and go? Is it related to menstrual cycle? Is lump tender? Does severity of tenderness change related to menstruation? Recently injured breast? Did lump develop after injury?

23. H x of Breast a n d Axilla Swelling / lump Redness, swelling, or dimpling associated with this lump? Other symptoms?

24. Hx of BSE Do you perform breast self-examination (BSE)? How often? Do you have regular breast examination by a health care professional? Have you ever had a mammogram? When? How often?

25. Physical Assessment Anatomical landmarks: quadrants of the breast, include Tail of Spence

26. Principles of physical assessment Wash hands Always explain procedure before you begin. Bring appropriate equipment to bedside ( Towel, drape, centimeter ruler, teaching aid for BSE ) Introduce self Verify correct patient Ensure privacy and Ensure comfort Obtain consent

27. Principles of physical assessment Position patient so she is sitting on exam table facing you, sitting erect with gown dropped to waist. Following inspection, assist patient into supine position so that breasts and nipples may be palpated. Patient positions Assess the following areas : Breasts , Areolar areas , Nipples , Axillae Expose only area needed Stand in front of the patient

28. Physical Examination Include : Inspection Palpation Documentation

29. Inspection Stand in front of the patient Position patient so she is sitting arms at sides on exam table facing you, sitting erect with gown dropped to waist. Inspect from 3 directions : Front,Left sides and Right side Inspect both breasts & axillae at (relaxed, arms raised, hands on hips , leaning forward and note shape, and symmetry , Skin changes (dimpling, retraction), ulceration, edema , redness , vascularity .

30. Inspection Raise arms above the head- Inspect supraclavicular area Inspect nipples for position, symmetry, characteristics, lesions, bleeding, and discharge. Location of concern and abnormality Documentation

31. Breast Palpation Supine position with small pad/pillow under side to be palpated Arm raised over head Normal side first Use pads of fingers and make gentle rotary movement on breast Use a pattern of concentric circles or laterally, like spokes of wheel. Palpate all areas of breast, clockwise fashion

32. Palpation Use the Middle of Your Fingers Fingertips are too sensitive (all breasts are somewhat lumpy) Palm is too insensitive Middle portion of fingers is just right

33. Palpation Bimanual Breast Palpation For pendulous breasts /Large Breasts Support inferior part of breast with one hand. Use other hand to palpate breast tissue against supporting hand. Ask for any painful area Palpate beast with palmer surface of the fingers for presence of lump

34. Palpation Lump characteristics: site, size, shape, surface, mobility, temperature, tenderness, texture, edge, attachment to skin or deep tissue While you are palpating note skin Thickening , mass , tenderness . Nipple: Performed after breast palpation for elasticity, masses, tenderness, Any retraction/ ulceration , discharge milky and Pathological ( blood , serum, pus ) Palpate nipple, noting any indurations or mass. Use thumb and forefinger to apply gentle pressure to note any discharge.

35. Palpation P a l p a t e axilla ( F e e l arm p i t ) Use the same circular motions. Feel for breast lumps and lymph nodes. Normal lymph nodes cannot be felt.

36. Palpation of axilla Palpate Lymph nodes: axillary, clavicular node while sitting.

37. Supine with shoulder support –Use pads of fingers of dominant hand

38. Normal finding Breast and axillae are flesh colored Areolar areas and nipples are darker in pigmentation Breasts, areolar areas, nipples should be symmetrical No thickening or edema and No dimpling, retraction Free from masses, tumors, lesions Right breast larger than left movable No discharge from nipples in nonpregnant, nonlactating female

39. Abnormal finding Palpable mass ( B e n i g n ( mobile ) - cyst , F i b r o adenoma , l i p o m a , malignant ( immobile ) - carcinoma ) ) Thickening, tenderness Mass or pain in the axilla Nipple discharge Oedema or erythema of the skin U l c e r ( Paget’s disease )

40. Gerontological Variations Breast tissue atrophy Decreased glandular tissue, resulting in granular feeling Breasts become smaller, pendulous, and flatter Ductal tissue becomes more palpable. Stringy feeling

41. BSE Performed once a month Performed on a fixed date each month, or eight days after menses Avoid completing during menstruation or ovulation Use calendar for monthly reminder Include significant other in examination process Early detection is important.

42. BSE Steps of self-breast examination: Two components: 1. Inspection (Preferably in standing position) 2. Palpation (Either lying down, sitting, standing) Inspection 1 . Standin : front of the mirror exposing the chest up to the waist, look at the breasts through the mirror, while keeping the arms in positions. Look at the size and shape symmetry, retractions, dimpling, inverted nipples, or nipple deviation of each breast and nipple. Check for swelling, lumps, scaly skin, or other skin changes.

43. BSE You may sit or stand to check your breasts in the following three ways. Look at your breasts with: o Your arms hanging down at your sides. o Your hands raised and joined behind your head. o Your hands placed firmly on your hips and bent slightly forward 2 LYING DOWN • When you lie down, your breast tissue spreads out evenly over your chest. This makes it easier for you to feel for lumps and any changes in your breasts. • Place a small pillow or towel under your left shoulder. Put your left arm behind your head.

44. Summary Assessing the breast includes: Take into account developmental level Remembering to assess both females and males Inspecting & palpating breasts,nipples, lymph nodes and axillary Teaching BSE

45. REFERENCES References 1. Bickley, L. S., Szilagyi, P. G., & Bates, B. (2007). Bates' guide to physical examination and history taking (11th Edi). Philadelphia: Lippincott Williams & Wilkins. Chapter No.06 & 07 p.n 171-250 2. Weber, Kelley's. (2007). Health Assessment in Nursing, 3rd Ed: North American Edition. Lippincott Williams & Wilkins. Chapter No.14 &15 p.n 239-294