Assessing Breasts and Axillae

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    Assessing Breasts and Axillae

    By

    Maria Kamile A. Garcia

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    DefinitionsBreast examination.

    It is the technique by which a thorough inspection

    & palpation of the breast is made during

    antenatal and postnatal period to collect data

    about the breastcondition of mother.

    Breast self examination( B S E).

    It mean the regular examination of breast

    performed by a woman in a systemic manner

    for the purpose of early detection of cancer

    breast(done monthly).

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    Purpose

    - To identify signs of breast disease and then to

    initiate early treatment.

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    Preparation:

    Verify the clients identity.Client will sit in an upright position

    Explain the procedure.

    Hand washing.

    Provide client privacy.

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    Ask for:

    History of breast masses and what was done

    about them.

    Pain or tenderness in the breasts and relation to

    the womans menstrual cycle.

    Discharge from the nipple.

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    Medication history (e.g., oral contraceptives,

    steroids, and diuretics) may cause nipple discharge.

    Risk factors (e.g., mother, sister, aunt with breast

    cancer, alcohol consumption, high fat diet, obesity,use of oral contraceptives, menarche before age 12,

    menopause after age 55, age 30 or more at first

    pregnancy

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    Inquire if the client performs breast self

    examination, technique used, and when performed

    in relation to the menstrual cycle.

    Estrogen replacement therapy may be associated

    with the development of cyst or cancer.

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    Assessing Breasts and axillae

    Deviation fromnormalNormal findingsAssessment

    -Recent change in

    breast size,

    swelling, markedasymmetry.

    rounded shape,Female:

    slightly

    unequal in size, generallysymmetric.

    breasts even withMale:

    the chest wall, if obese

    may be similar in shape

    to female breasts.

    Inspect the

    breasts for:

    Size.Symmetry.

    Shape.

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    Inspect for:

    Skin changes

    Redness

    Visible bumps Nipple crusting

    Symmetry

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    Deviation from

    normal

    Normal findingsAssessment

    Any a symmetry,mass, or lesion.-Rounded or ovalbilaterally the same,

    --Color varies from

    light pink to dark

    brown.

    -Irregularplacement of

    sebaceous glands

    on the surface of

    areola.

    Inspect the areolaarea for size, shape,

    symmetry, color,

    surface

    characteristics, and

    any masses orlesions.

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    Deviation from normalNormal findingsAssessment

    -A symmetrical size and

    color.

    -Presence of discharge,

    crusts, or cracks.

    -Recent inversion ofone or both nipples.

    -Rounded, everted and

    equal in size.-Similar in color,

    smooth, soft, both

    nipples point in same

    direction.

    - No discharge, exceptfrom pregnant or breast

    feeding females.

    -Inversion of one or

    both nipples that is

    present from puberty.

    Inspect the nipples for

    size, shape, position,color, discharge, and

    lesions.

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    Deviation from

    normal

    Normal findingsAssessment

    -Localized

    discolorations or

    hyperpigmentation.

    -Retraction or

    dimpling.-Unilateral localized

    hypervascular areas.

    -Swelling or edema

    appearing as pig skinor orange peel due

    to exaggeration of

    the pores.

    Skin : uniform in

    color and skin is

    smooth and intact.

    Striae, moles andnevi.

    *Inspect the skin for

    localized

    hyperpigmentation,

    retraction or

    dimpling, localizedhypervascular

    areas, swelling or

    edema.

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    Deviation

    from normal

    Normal

    findings

    Assessment

    Breasts should rise

    evenly Watch for

    dimpling or retraction

    *Emphasize anyretraction by having the

    client:

    -Raise the arms above

    the head.

    -Push the hands

    together, with elbows

    flexed.

    -Press the hands down

    on the hips.

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    Deviation from normalNormal

    findings

    Assessment

    -Tenderness, masses,

    nodules, or nipple

    discharge.

    If a mass was detected,

    record the following

    data:

    A-Location and

    distance from the

    nipple in cm.

    No

    tenderness,

    masses,

    nodules, or

    nipple

    discharge.

    Palpate the breasts for masses,

    tenderness, and any discharge

    from the nipples.

    Client position: lie down, place

    overhead the arm on the same

    side as the breast being

    palpated. Place a small pillow or

    rolled towel under the breast

    being palpated.

    Rationale: The breasts flatten

    evenly against the chest wall,

    facilitating palpation

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    Feel for Lumps

    Raise the arm

    Feel with opposite

    hand Feel for a marble in a

    bag of rice

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    Use the Middle of Your Fingers

    Fingertips are too

    sensitive (all

    breasts are

    somewhat lumpy) Palm is too

    insensitive

    Middle portion offingers is just right

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    Move your hand in small

    circles Stay in one place

    Press in while circling

    with your hand

    Feel for thickenings

    the size of a marble

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    Try to Express Nipple

    Discharge Strip the ducts towardsthe nipple.

    Normally, one or two

    drops of clear, milky orgreen-tinged

    secretions.

    Should not be bloodyor in large quantity,

    squirting out or

    staining the inside of a

    bra.

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    Assessment

    Circular or clockwise and Wedged

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    3-Vertical strips pattern:

    Start at one point for palpation, and movesystematically to the end point to ensure that

    all breast surfaces are assessed.

    Teach the client the technique of breast selfexamination.

    Document findings.

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    The Axillae Use the same circular

    motions.

    Feel for breast lumps

    and lymph nodes. Normal lymph nodes

    cannot be felt.

    Enlarged lymph nodes

    are about the size of a

    pencil eraser, but

    longer and thinner.