HEALTH ASSESSMENT-BREAST AND AXILLA.pptx

HEALTH
ASSESSMENT:
BREAST AND
AXILLAE
By: ROMMEL LUIS C. ISRAEL III
BY: ROMMEL LUIS C. ISRAEL III
1

THE BREAST
2

ASSESSMENT TECHNIQUES
USED:
Inspection
Palpation
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5

ANATOMY
PHYSIOLOGY
• Divided into four quadrants based on
horizontal and vertical lines crossing
at the nipple
• Axillary tail of breast tissue extends
toward the anterior axillary fold
• Findings can be localized as the
time on the face of a clock (e.g.
3o’clock) and the distance in
centimeters from the nipple
After assessing the breast of a female
client, the nurse should explain to the
client that most breast tumors occurs in
the
6

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• The breast is hormonally sensitive
tissue, responsive to the changes
of monthly cycling and aging.
• Glandular tissue: secretory
tubualveolar ducts, lobules –
drains into the nipples or arreola
• Fibrous connective tissue: support
• Adipose tissue: varies with age, the
general state of nutrition,
pregnancy, exogenous hormone, ad
other factor.
8

.
MA1OR
M.
ilary
a·
1 of
Spence
reola
Serraus
neriorm.
N
Montgo
glands
9

-
e
r
L
o e
r i n n e r A
q u a d r a n t
81r e a s q u a d r a n t s . T h e u p p e r o u t e r q u a d r a n t i s
o s t a r g e t e d b y b r e a s t c a n c e r .
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ADVANTAGES OF BSE:
 Women can use BSE to assess their
breast
 When they perform BSE properly and
regularly, they can note any changes in
their breast and seek further evaluation
 Examination should be done every
month and at the end of menses in all
menstruating women.
14

However, breast self-exams help
you familiarize yourself with the
shape, size, and texture of your
breasts.
This is important because it can
help you determine if what you are
feeling is normal or abnormal.
Any time you feel an abnormality in
your breast, tell your doctor.
15

Barriers to BSE
Lack of confidence
Lack of knowledge and
awareness
16

17

ASSESSMENT SKILLS:
Preparation prior to assessment
1. Gather equipment:
Centimeter Ruler
Small pillow
Gloves
Clients handout for Breast Self-
Examination
Slide for specimen (if there is any)
18

2. EXPLAIN THE PROCEDURE TO
THE
CLIENT
- what the steps of the examinations
are and the rationale for them.
Wash your hands
Warm your hand
Provide privacy.
3. Assist client to put on gown.
19

FEMALE BREAST:
1. Inspect for
a. size and symmetry
b. color and texture
c. superficial venous patterns
d. areolas e. nipples
f. retraction and dimpling
g. bilaterally, note color, shape & texture of
areolas
g. bilaterally, note size &
direction of nipples
20

2. PALPATES FOR:
a. texture and elasticity.
b.Tenderness and Temperature
(warmth or inflammation)
c. Masses
Note for location, size in centimeter,
shape mobility, consistency, and
tenderness.
Note the condition of skin over the mass
21

3. Palpates nipples by compressing
nipple gently between thumb and index
finger; observe for discharge
22

4.Palpates mastectomy or
lumpectomy site, if applicable
Observing the scar, and any
remaining breast or axillary tissue for
redness, lesion, lumps, swelling or
tenderness.
23

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Women who do not menstruate should
choose a certain day to perform the
exam, such as the first of each month.
You should also keep a journal of your
self-exams. This will help you track and
record any changes you have noticed in
your breasts.
26

ASSESSMENT
PROCEDURE
FEMALE BREAST
1. Inspects breast for
A. SIZE AND SYMMETRY
Have the client disrobe and sit with arms
hanging freely. Explain what you are
observing to help ease client anxiety.
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Normal Findings:
 Breasts can be a variety of sizes and are
somewhat round and pendulous; one
breast may be larger than the other.
 The older client often has more pendulous,
less firm and saggy breasts.
33

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Abnormal
Findings:
 A recent
increase in the
size of one
breast may
indicate
inflammation or
an abnormal
growth.
35

A pig skin like or orange peel/ peau
d’orange appearance results from edema,
which is seen in metastatic breast disease.
The edema is caused by blocked lymphatic
drainage.
36

B. COLOR AND TEXTURE
Normal Findings:
 Color varies depending on the client’s skin tone. Texture is
smooth with no edema.
 Linear stretch marks may be seen during and after
pregnancy or with significant weight gain or loss
37

Abnormal Findings:
Redness is associated with
breast inflammation
38

C. SUPERFICIAL VENOUS
PATTERNS OBSERVE VISIBILITY
AND PATTERNS OF BREAST
VEINS.
Normal Findings:
Veins radiate either horizontally
or and toward the axilla
(transverse) or vertically with a
lateral flare (longitudinal)
39

Abnormal Findings:
A prominent venous pattern may occur
as a result of increased circulation due
to a malignancy. An asymmetrical
venous pattern may be due to
malignancy
40

D. RETRACTION AND
DIMPLING
 Ask the client to remain seated while performing
several different maneuvers. Ask the client to
raise her arms overhead, then press her hands
against her hips. Next ask her to press hands
together.
41

NORMAL FINDINGS:
 The client’s breasts should rise
symmetrically with no sign of dimpling
or retraction
Abnormal Findings:
 Dimpling or retractions is usually caused by malignant
tumor that has fibrous strands attached to the breast
tissue and fascia of the muscles. As muscles contracts, it
draws the breast tissue and skin with it, causing dimpling
and
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D. RETRACTION AND
DIMPLING (CONT..)
 Finally, ask the
client to lean
forward from
waist. This is a
good position to
use in women
who have large
pendulous
44

NORMAL FINDINGS:
 Breast should hang freely and
symmetrically.
Abnormal Findings:
 Restricted movement of breast
or retraction of the skin or
nipple indicates fibrosis and
fixation of the underlying
tissues. This is usually due to an
underlying malignant tumor.
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D. Areolas
E. Nipples
F. Retraction and Dimpling
G.BILATERALLY, NOTE
COLOR, SIZE, SHAPE,
AND TEXTURE OF
AREOLAS
Normal Findings:
 Areolas vary from dark
pink to dark brown
depending on the client’s
skin tones. They are round
and may vary in size.
Small Montgomery
tubercles are present.
47

ABNORMAL FINDINGS:
 Peau d’orange skin, associated with
carcinoma
 Red, scaly crusty areas
48

H. BILATERALLY, NOTE SIZE AND
DIRECTION OF NIPPLES
Normal Findings:
 Nipples are nearly equal bilaterally in size
and are in the same location on each
breast. Nipples are usually everted but they
may be inverted or flat. Supernumerary
nipples may appear
 The older client may have smaller, flatter
nipples that are less erectile on stimulation
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EXAMPLE OF SUPERNUMERARY NIPPLE
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Abnormal Findings:
A recently retracted nipple that
was previously everted suggests
malignancy. Discharges should
be referred for cystologic study
and further evaluation
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UIDELINES FOR PALPATING THE
BREAST
 Ask the client to lie down and to 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.
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 Use the flat pads of three fingers to
palpate the client’s breast.
55

 Palpate the breast using one of three different patterns.
 Circular/ clockwise
 Wedge
 Vertical strip
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 Be sure to palpate every
square inch of the breast
from the nipple to areola to
the periphery of the breast
tissue and up into the tail
of Spence. Vary the levels
of pressure as you palpate
 Light- superficial
 Medium- mid level
tissue
 Firm- to the ribs
57

2. PALPATES BREAST FOR
A. TEXTURE AND ELASTICITY
Normal Findings:
 Smooth, firm , elastic tissue
Abnormal Findings:
 Thickening of the tissues may occur with an
underlying malignant tumor.
58

B. TENDERNESS AND
TEMPERATURE
Normal Findings:
A generalized increase in nodularity and
tenderness may be normal findings
associated with menstrual cycle or
hormonal medications. Breasts should
be a normal body temperature.
59

ABNORMAL FINDINGS:
Painful breast may be indicative of
benign breast disease but can also
occur in malignant tumor
Heat in the breasts of women
who have not just given birth or
who are not lactating indicates
inflammation.
60

C. MASSES: NOTING LOCATION, SIZE IN
CENTIMETERS, SHAPE, MOBILITY,
CONSISTENCY, AND
TENDERNESS.
Normal Findings:
No masses
Abnormal Findings:
 Malignant tumors are most often found in the uppe
outer quadrant of the breast. They are unilateral,
with irregular, poorly delineated borders. Hard and
non-tender and fixed to underlying tissue
61

3. PALPATES NIPPLES BY COMPRESSING NIPPLE
GENTLY BETWEEN THUMB AND INDEX FINGER;
OBSERVE FOR DISCHARGE
 Ask client to lie down, raise right arm and
check the right breast, repeat procedure to
the left breast.
 Wear gloves to compress the nipple gently with
your thumb and index finger. Note any discharge.
 If spontaneous discharge occurs from the nipples,
a specimen must be applied to a slide and the
smear sent to the laboratory for cytologic
evaluation
62

63

Normal Findings:
 The nipple may become erect
 A milky discharge is usually present only during
pregnancy and lactation.
Abnormal Findings:
 Discharge may be seen in endocrine disorders
and with certain medications ( anti hypertension,
estrogen)
 Cancer of the breast, fibrocystic disease
64

4. PALPATES MASTECTOMY
SITE /
LUMPECTOMY SITE, IF
APPLICABLE, OBSERVINGTHE
SCAR AND ANY REMAINING
BREAST OR AXILLARY TISSUE
FOR REDNESS, LESIONS,
LUMPS, SWELLING, OR
TENDERNESS
Ask client to sit down then
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NORMAL FINDINGS:
 Scar is whitish with no redness or swelling.
No lesions, lumps or tenderness noted
Abnormal Findings:
 Redness, inflammation of the scar may indicate
infection
 Any lesions, lumps or tenderness should be
referred for further evaluation.
67

MALE BREAST
1. INSPECT THE BREASTS, AREOLAS,
AND NIPPLE FOR SWELLING,
NODULES, OR ULCERATIONS
Normal Findings:
No swelling or ulcerations
68

ABNORMAL FINDINGS:
Soft, fatty enlargement of the breast tissue
is seen in obesity. Gynecomastia, a smooth
firm movable disc of glandular tissue may
be seen in one breast in males during
puberty for a temporary at a time. Also
seen in hormonal imbalance, drug abuse,
leukemia
Irregularly shaped, hard nodules occur in
the breast
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GYNECOMAST
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2. PALPATES THE BREAST, AREOLAS,
AND NIPPLES FOR SWELLING,
NODULES, OR ULCERATIONS
Normal Findings:
 No swelling , nodules/ ulceration
Abnormal Findings:
 Hard nodules, swelling, presence of
ulcerations/ lesions
72

ASSESSMENT
PROCEDURE
AXILLAE
1. INSPECT THE AXILLARY
SKIN FOR RASHES AND
INFECTION.
Ask the client to sit up.
73

NORMAL FINDINGS:
 No rash or infection noted
Abnormal Findings:
 Redness and inflammation may be seen in
infection of the sweat gland.
 Dark, velvety pigmentation of the axillae –
acanthosis nigricans, may indicate an
underlying malignancy
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2. HOLDS THE ELBOW WITH ONE HAND
AND USE THE THREE FINGER PADS OF YOUR
OTHER HAND TO PALPATE FIRMLY THE AXILLARY
LYMPH NODES.
Normal Findings:
 No palpable nodes or one to two small (less than 1 cm)
discrete, non-tender, movable nodes in the central area.
Abnormal Findings:
 Enlarged greater than 1 cm lymph nodes may indicate
infection of the hand or arm.
 Large nodes that are hard and well-fixed to the skin may
indicate malignancy
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3.Palpates high into the axillae,
moving downward against the ribs
to feel for the central nodes.
Continue down the posterior
axillae to feel for the posterior
nodes.
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79

USE BIMANUAL PALPATION TO FEEL FOR
THE
ANTERIOR AXILLARY NODES.
Palpate down The inner aspect of the upper arm.
If the client has large breast, support breast with your non dominant
hand, and use your dominant hand to palpate.
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4. Ask the client to demonstrate how she
performs breast self- examination (BSE).
(This should be offered as an option and
the client’s choice)
82

S E L F -
A R E A S S E L - T = - E X A M I N A -
O N
83

B R E A S T S E F -
E X A M I N A T I O N
1 . L i e d o w n a n d p u y o u r l e f t a r m u n d e r
y o u r h e a d . U s e y o u r r i g h t h a n d t o
e x a m i n e y o u r l e f t b r e a s t . V V i t h y o u r
3 m i d d l e f i n g e r s f l a t , m o v e g e n t r y i n
s m a l l c i r c u l a r m o t i o n s o v e r t h e e n t i r e
b r e a s t , c h e c k i n g f o r a n y Iu
m
p h a r d
k n o t , o r t h i c k e n i n g . U s e d i f f e r e n t
l e v e l s o f p r e s s u r e - U g h t , m e d i u m , a n d
f i r m - o v e r e a c h a r e a o f y o u r b r e a s t .
C h e c k t h e w h o l e b r e a s t , f r o m y o u r
c o l l a r b o n e a b o v e y o u r b r e a s t d o w n o
t h e r i b s b e l o w y o u r b r e a s t . S w i t c h a r m s
a n d r e p e a t o n t h e o t h e r b r e a s t .
2 . L o o k a t y o u r b r e a s t s
w h i l e s t a n d i n g i n f r o n t
o f a m i r r o r w i t h y o u r
h a n d s o n y o u r h ip s .
L o o k f o r l u m p s . n e w
d i f f e r e n c e s i n s i z e a n d
s h a p e , a n d s w e l l i n g o r
d i m p 1 i n g o f t h e s k i n .
3 . R a i s e o n e a r m , . t h e n
t h e o th er , so you can
c h e c k u n d e r y o u r
a r m s f o r l u m p s .
4 . S q u e e z e t h e n f p p l e o f e a c h b r e a s t g e n U y
b e t w e e n y o u r t h u m b a n d i n d e x f i n g e r .
R e p o r t t o y o u r h e a l t h c a r e p r o v i d e r r i g h t
a w a y a n y d i s c h a r g e o r f l u i d f r o m t h e
n i p p l e s o r a n y l u m p s o r c h a n g e s i n y o u r
b r e a s t .
84

BREAST SELF-EXAMINATION
 Lie down and place your right arm behind
the head. The exam is done while lying
down, and not standing up, because
when lying down the breast tissue
spreads evenly over the chest wall as
thinly as possible, making much easier to
feel all breast tissue.
85

Use the finger pads of the three
middle fingers on your left hand to
feel for lumps in the right breast.
Use overlapping dime-sized
circular motions of the finger pads
to feel the breast tissue
86

 Use three different levels of pressure to feel all the
breast tissue. Light pressure is needed to feel the
tissue closest to the skin; medium pressure to
feel a little deeper; and firm pressure to feel the
tissue closest to the chest and ribs. A firm ridge in
the lower curve of each breast is normal. If your
not sure how hard to press, talk with your doctor or
nurse. Use each pressure level to feel the breast
tissue before moving on to
87

 Move around the breast in an up-and- down
pattern starting at an imaginary line drawn
straight down your side from the underarm and
moving across the breast to the middle of the
chest bone (sternum or breastbone). Be sure to
check the entire breast area going down until you
feel only ribs and up to the neck or collar bone
(clavicle).
There is some evidence to suggest that the
up-and-down pattern (sometimes called the
vertical pattern) is the most effective pattern
for covering the entire breast and not missing
any breast tissue.
88

 Repeat the exam on your left hand. While standing in front
of the mirror with your hands pressing firmly down on your
hips, look at your breasts for any changes of size, shape,
contour, or dimpling. (the pressing down on the hips
position contracts the chest wall muscles and enhances
any breasts changes).
 Examine each underarm while sitting up or standing and
with your arm only slightly raised so you can easily feel in
this area. Raising your arm straight up tightens the tissue
in this area andmakes
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