NURS1543 Final Exam notes
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School
York University *
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Course
1543
Subject
Anatomy
Date
Apr 3, 2024
Type
Pages
53
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NURS1543: Final Exam Notes
WEEK 6: Chapter 18 and 19
Chapter 18: Breasts and Regional Lymphatics
LO1: Self-review relevant anatomy and physiology
Breast and mammary glands
-
Female breast
o
Accessory reproductive organ which purpose is to produce milk
4 quadrants of breasts
1.
Upper inner quadrant (inside)
2.
Upper outer quadrant (outside) – site of most breast tumours
3.
Lower inner quadrant (inside)
4.
Lower outer quadrant (outside)
NOTE:
There’s also the tail of spence which extends to the
axillary
Surface anatomy
-
Nipple
o
Milk duct openings where the milk comes out
-
Areola
o
Filled with little dots called Montgomery
glands (sebaceous glands) which purpose is to
produce an oily substance material
o
When the baby latches on, it provides moisture and helps lubricate the nipple b/c
the nipple can get quite dry
-
Location of the breast
o
Anterior to the pectoralis major and serratus anterior muscles
o
b/w 2
nd
and 6
th
ribs
Internal anatomy
-
Glandular tissue
o
These are composed of lobes, lobules, and alveoli
▪
In the alveoli, the milk is created and stored
-
Lactiferous ducts and sinuses
o
Store milk
-
Fibrous tissue
o
Aka Cooper’s ligaments or suspensory ligaments – the breast is full of this and
purpose is to support that breath tissue
-
Adipose tissue
o
Where lobes are embedded
o
These are layers of substances and retromammary fat which provides the bulk of
the breasts
NOTE:
Size of breasts depends on the adipose varies w/ age, cycle, pregnancy, location, general
nutritional state
Lymphatic system
-
Breast has extensive lymphatic drainage
-
Most of the lymph nodes – more than 75%, drains into axillary nodes
4 groups of axillary nodes
1.
Central axillary nodes
o
In the middle of your axilla
o
Over the ribs and serratus anterior muscle
o
Receives lymph from the other nodes
2.
Pectoral (anterior)
o
Along the pectoralis major
o
More at the front
3.
Subscapular (posterior)
o
Deep in the posterior axillary fold
o
More in the back
4.
Lateral
o
Along the humerus
o
Inside the arm
LO2: Outline developmental and cultural considerations and health
promotion strategies
Adolescents
-
Estrogen hormones stimulate breast changes at puberty
-
Beginning of breast development is prior to menarche
-
One breast may grow faster than the other
o
Results in temporary asymmetry which is normal
-
Tenderness in this stage
-
Full development may take up to 3 years
-
Nodularity increases from midcycle to menstruation
o
During 3-4 days before period, breasts feel full, tight, heavy, sore
o
Breast gets smaller on days 4-7 of the period
-
Tanner staging – involves 5 stages
-
Thelarche – refers to the beginner of breast development
-
Menarche – comes after thelarche which is the beginning of menstruation by about 2
years after you develop your breast
o
Occurs at stage 3 or 4
o
Around 8-10 yrs of age
-
Supernumerary nipple – it’s just an extra nipple developed along the tract of the
mammary ridge
Pregnant women
-
Breast changes during the 2
nd
month which indicates an early sign of pregnancy
-
Stimulation of expansion of ductal system and supporting fatty issue, as well as
development of the true secretory alveoli
-
Breast get bigger and feel more nodular (just more round, full, big)
-
Nipples get larger, darker, erectile
-
Areolae get larger and darken as pregnancy progresses
o
Never return in colour
-
After the 4
th
month, colostrum is expressed – thick yellow fluid
o
Contains antibodies that is rich and important for the baby
-
Milk production or lactation begins 1 to 3 days postpartum
Older women
-
After menopause, there’s a decrease in estrogen and progesterone therefore causing the
breast to start atrophy
-
Atrophy of tissue
-
Breast size and elasticity decreases therefore resulting in saggy or droopy boobs
-
Inner structures might be more prominent
Cultural and social considerations
-
Indigenous populations
o
Cancer mortality rate is increasing
o
Lack of underscreening b/c of lack of access, negative experiences, lack of
understanding
-
Immigrants
o
Language barriers, transportation options, lack of familiarity with the procedure
-
Western culture
o
Obesity being associated with breast cancer
o
Breast being more than use of lactation
-
Incidence/mortality rates
o
Affected by SES, rural locations, ethnocultural backgrounds
-
Risk factors
o
Includes obesity, nulliparity (not being pregnant ever) or first child after 30 (tend
to be rich people), hormonal contraception, alcohol
-
You need to be culturally sensitive
-
Life-time risk for being diagnosed with breast cancer is 1:9
-
Women who have a 1
st
degree relative who had breast cancer have a 1:7 chance
Health promotion strategies
-
Breast cancer
o
Screening, mammography, MRI, Clinical breast examination, breast
self-examination
o
Most common cancer in women
-
Increasing patient’s knowledge, encouraging them to screen
o
Breast cancer and hormone therapy
o
All women should be familiar with their own breasts
-
Screening recommendation/tools
-
Early detection for individuals at high risk
o
Gail model – breast cancer risk assessment tool
o
Pedigree assessment tool – better considers risks associated with hereditary breast
cancers
-
Breast self-examinations are no longer routinely recommended for women ages 40-74
and those who have an avg. or low risk for breast cancer
-
Mammography every 2-3 years age 50-74
LO3: Outline and practice subjective questions to be asked of client
Subjective questions (health history) you need to ask client about their breasts:
-
Pain
o
“Is it cyclical?” is an important question to ask cause of their cycle
o
OPQRST
o
Ask the client to map it out
o
Abnormal finding:
▪
Mastalgia – breast pain which occurs w/ inflammation, trauma, infection,
benign breast disease
-
Lump
o
If there is lump that they said, also do OPQRST
o
Redness, swelling, warmth, dimpling associated with the lump
-
Discharge
o
Ask for colour, consistency, smell, texture
o
Abnormal finding:
▪
Galactorrhea – secretion of milky-white discharge
-
Rash
o
OPQRST
-
Swelling
-
Trauma
-
History of breast disease, and breast cancer risk factors
-
Surgery
-
Self-care behaviours
o
If they do breast self-examination (BSE)
o
If they did mammography
Subjective questions (health history) you need to ask client about their axilla:
-
Tenderness, lump, swelling
o
OPQRST
-
Rash
o
Ask them to describe it
LO4: Identify equipment needed for physical examination, and identify
guidelines for preparation of objective data collection and identify critical
findings that may be found
Equipment
-
Small pillow
-
Ruler marked in cm
Preparation
-
Woman sitting up when you start
-
Provide draping
-
When women is supine with palpation, cover one breast
-
Be sensitive
-
Wash hands
-
Introduce self
-
Explain the procedure
LO5: Explain how to inspect and palpate breasts and axillae and regional
lymphatics
Inspection of the breast
-
General appearance
o
Note symmetry, shape
o
Often, left is bigger than right
-
Skin
o
Normally smooth and even colour
o
Note any redness, bulging, dimpling, lesions, edema
o
Edema – orange look (swelling of the breast), different from enlarged breast
o
Blue vascular network is normal during pregnancy and pale linear striae or stretch
marks
-
Lymphatic drainage areas
o
Observe axillary and supraclavicular regions
o
Note any bulging, discoloration, edema
-
Nipple
o
Normally symmetrical, protruded, can be pulled out
o
Not any dry scaling, fissure, ulceration, bleeding, discharge (colour, odour,
texture)
NOTE:
Critical findings include discharge, bleeding, ulcerating lesion, mass in a client
previously diagnosed with cancer
Manoeuvres that you do to screen for retraction
-
Retraction – results from fibrosis in the breast tissue caused by growing neoplasm
-
Lifting arms over the head = breast should move symmetrically
-
Pushing hand to the hips = both breasts are lifted slightly
-
Pushing two palms together = both breasts are lifted slightly
-
With woman w/ large breast, ask them to lean forward = should be symmetrical
Inspection and palpation of the axillae
-
Inspect skin for rashes and infection
-
Palpate axilla for tenderness and axillary nodes – reach your fingers high into the axilla
and move them firmly down in 4 directions
o
Down chest wall in a line from middle of axilla
▪
Central axillary nodes
o
Along anterior border of axilla
▪
Pectoral/anterior axillary nodes
o
Along posterior border of axilla
▪
Subscapular/posterior axillary nodes
o
Along inner aspect of upper arm
▪
Lateral axillary nodes
Palpation of the breast
-
Positioning:
o
Put them in supine position
o
Tuck a small pad under the side to be palpated and raise her arm over her heard
therefore flattening the breast tissue
o
So significant lumps will then feel more distinct
-
Techniques
o
Use of 3 fingers
o
Varying pressure
-
3 motions that you do when palpating – or palpation patterns
o
Vertical strip pattern – up and down
▪
Currently recommended b/c it best detects a breast mass
o
Spokes-on-a-wheel pattern – from the centre to out
o
Concentric circles pattern – circular
-
Palpate the nipple
o
Note any induration or subareolar mass
o
Pinching the nipple
o
Note for discharge
o
With larger breast, do a bimanual technique which is just using your two hands
Breast lumps
-
If you palpate and notice lumps, examine the unaffected breast first to serve as your
baseline normal consistency
-
Assess for:
o
Location – use the clock “2:00”
o
Size – use cm in 3 dimensions W x L x thickness
o
Shape – note whether oval, round, lobulated, indistinct
o
Consistency – whether soft, firm, hard
o
Movable – freely movable or fixed
o
Distinctness – whether solitary or multiple
o
Nipple – whether the lump is displaced or retracted
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