NURS 304 Breast & Regional Lymphatics
The nurse is teaching an adolescent who was diagnosed with fibroadenoma in the left breast. Which statement by the nurse would be appropriate?
"It is benign and may resolve spontaneously."
The nurse is caring for a lactating patient who has a breast abscess on the right breast. Which instructions should the nurse provide to this patient?
"Nurse only on the unaffected side."
During a physical assessment, a teenager tells the nurse, "My left breast is smaller than the right one and it makes me feel self-conscious." How should the nurse respond?
"You shouldn't worry; this is a normal condition."
areola
darkened area surrounding nipple
retraction
dimple or pucker on the skin
gynecomastia
enlargement of the male breast
what is the current recommendation for women 40+ years for breast cancer screening?
every year
tail of spence
extension of breast tissue into the axilla
paget disease
intraductal carcinoma in the breast
reservoirs of milk
laciferous sinuses
what is present at birth in infants
lactiferous ducts
The nurse is caring for a patient with a plugged duct. How much time does it take to resolve this condition if properly treated?
less than a day
The nurse is screening a patient for retraction of the breasts. How does the nurse instruct the patient during this screening?
-"Push the palms together." -"Put both the hands on the hips." -"Lift both the arms slowly over the head."
What care does the nurse take while palpating the breasts of a patient?
-Assist the patient to a supine position. -Tuck a pad under the side to be palpated. -Have the patient raise the arm over the head.
What does the nurse teach a patient about changes in the breast during pregnancy?
-Breast milk is produced 1 to 3 days after delivery. -The breast surface develops a venous pattern. -Colostrum may be expressed beginning in the fourth month of pregnancy.
What does the nurse teach the patient about breastfeeding?
-Breast milk is whitish and contains proteins, lactose, and fats. - The breasts produce colostrum for the first few days after delivery. - The antibodies in colostrum protect the newborn against infection.
The nurse is teaching nursing students about fibrocystic disease. Which signs and symptoms should the nurse include in the teaching plan?
-Mastalgia -Nipple discharge -Swelling and tenderness
What are the appropriate nursing interventions while examining the breast of a male patient?
-Palpate the nipple area and axillary lymph nodes. -Combine with the examination of the anterior thorax. - Inspect the chest wall and the skin surface for lumps.
The nurse is caring for a patient with benign fibrocystic breast disease. What does the nurse expect to find in this patient?
-Presence of multiple tender masses -Presence of dull, heavy, cyclic pain -Presence of cysts and fibroadenomas
What is the best intervention by the nurse while assessing a patient over the age of 50?
-Suggest use of talcum powder for breast self-examination. -encouraged to undergo clinical breast examination every year
Which areas does the nurse examine to rule out any obstruction of lymphatic drainage?
-The infraclavicular region -The supraclavicular region -The axillary region
Non-modifiable risk factors for breast cancer
-age >50 - mutation of BRCA 1 and 2 - first degree relative w/BC - previous breast disease/irradiation -early menstruation (<12), late menopause (>50) -caucasion
breast development at puberty
-estrogen stimulates breast change - breast tenderness -occurs ages 8-10 (can happen later)
advanced breast cancer
-firm, hard, irregular axillary nodes -skin dimpling -nipple retraction or elevation -discharge
The nurse is teaching a patient about the factors that can decrease the risk for breast cancer. Which foods does the nurse encourage the patient to consume?
-fruits -veggies -sunflower oil
unusual palpation of breasts
-heat -redness -swelling -discharge
mastisis
-inflammation of the breast -flu-like symptoms -before abscess formation
What interventions are appropriate for a nurse caring for a 22-year-old female patient who expresses the desire to learn the process of breast self-examination (BSE)? Select all that apply.
-inspect breast in the shower and in supine position
characteristics of a breast lump
-location -size, shape -consistency -movable -distinctness -nipple -skin over it -tenderness -lymphadenopathy
examples of self care behavior
-monthly breast exams - mammogram
Modifiable risk factors for breast cancer
-nulliparity or 1st child after 30 -recent oral contraceptive use -postmenopausal HRT -not breast feeding -drinks 1 or more cups a day - obesity - sedentary lifestyle
subjective data of breasts
-pain -lumps -discharge -rash -swelling -trauma -history of breast disease -tenderness, rash of axilla
inflammatory breast cancer
-rare -symptoms: redness, edema, heat, peau d'orange, nipple retraction, pain, itching, may not have distinct lumps -hard to treat, grows quickly
tanner staging
-staging of sexual maturity -5 stages
unusual inspection of breasts
-sudden increase in size -redness -hyperpigmentation -unilateral dilated veins in a non-pregnant female -edema -bulging of lymphatic drainage -discharge -nipple retraction/inversion/deviation
breast cancer
-usually hard, irregular, non-tender mass - usually directly under the areola
Which patient is likely to have mammary duct ectasia?
A perimenopausal woman who has lactated
The nurse is performing a clinical breast examination (CBE) on a patient. Which assessment finding should the nurse refer for further investigation?
A recent increase in size in one of the breasts
What is a normal finding in the breasts of a prepubertal child?
The areola has darker pigmentation with flat nipples.
What is the marked change in the breast seen in a patient who has reached menopause?
Atrophy of the glandular tissue
During the physical examination of a prepubertal child, the nurse documents "premature thelarche." What does this indicate?
Early development of breasts without hormone-dependent signs
What nipple discharge does the nurse expect to find in a patient with early lesions in Paget disease?
Clear, yellow discharge
Which information should the nurse provide to a lactating patient with a plugged duct?
Ensure complete emptying of the breast.
What is the cause of gynecomastia in a patient with Cushing syndrome?
Inability to metabolize estrogens
The nurse is assessing a patient with large, pendulous breasts for retraction. Which is the best intervention by the nurse?
Instruct the patient to lean forward as the nurse supports the arms.
Where does more than 75% of lymph from the breasts drain?
Ipsilateral axillary nodes
ectasia
It is caused by the stagnation of cellular debris and secretions in the ducts, leading to obstruction, inflammation, and infection.
What is a characteristic of fibroadenoma?
It is freely moveable and feels firm and elastic.
The nurse is caring for a patient with cracked nipples due to breastfeeding. What instructions should the nurse provide to the patient?
Keep the area clean, dry, and exposed to the air.
What is the term used by the nurse to describe pain in the breast?
Mastalgia
The nurse is caring for a patient in the second month of lactation. The patient has an inflammatory mass forming outward from the areola and flu-like symptoms. What is the diagnosis for this patient?
Mastitis
Atrophy of the glandular tissue
Ovarian secretion of estrogen and progesterone decreases after menopause.
The breast has four groups of axillary nodes. Where is the central axillary node located?
Over the ribs and serratus anterior muscle
What is a sign of skin tether in the breast?
The areola seems distorted and has a dimple, sign of retraction
The nurse is examining the breast of a patient. The nurse observes a small crust on the nipple apex that has spread to the areola. Which condition does the nurse suspect in the patient?
Paget's disease
Which assessment finding does the nurse associate with fibrocystic disease?
Pain increase before menses
The nurse notices edema on the breast skin of a patient that has a "pigskin" look. Which condition does the nurse suspect from this observation?
Peau d'orange
The nurse is assessing a patient who reports purulent nipple discharge. What is the likely cause of this condition?
Stagnation of cellular debris in the ducts
What assessment finding does the nurse identify with gynecomastia in an older male patient?
Presence of a bilateral, tender, firm mass. not as hard as a breast cancer mass
Which assessment finding in a patient may indicate breast cancer?
Presence of a unilateral, dense, irregular mass
The nurse is assessing a patient who reports feeling nodules in the breast. Further assessment reveals that the patient is in the midcycle of menstruation. What is the best intervention by the nurse?
Repeat the examination a week after menstruation.
What changes related to aging does the nurse expect to find during the examination of the breast in an elderly patient?
The breasts decrease in size and elasticity.
The nurse is assessing a patient's breasts. Which finding does the nurse identify as abnormal?
The presence of localized redness with heat
Which assessment finding does the nurse associate with a diagnosis of peau d'orange?
The skin is thickened, and the hair follicles exaggerated.
The nurse is assessing a patient after a mastectomy on the right side. Which assessment finding is a cause for concern?
There is redness and warmth around the scar.
Before a breast examination, the nurse asks the patient to lie down and raise her arms. What is the rationale behind this instruction?
To flatten the breast tissue, this facilitates the detection of significant lumps
What is the function of the Cooper's ligaments in the breast?
To support the breast tissue, These consist of fibrous connective tissue extending vertically from the skin surface to attach on the chest wall muscles
striae
atrophic pink, purple, or white linear streaks on the breasts, associated with pregnancy, excessive weight gain, or rapid growth during adolescence
thelarche
beginning of breast development
Fibroadenoma
benign breast mass
lactiferous
conveying milk
supernumerary nipple
minute extra nipple along the embryonic milk line
inverted
nipples that are depressed or invaginated
The nurse is doing a breast assessment of a pregnant patient. On palpation, the nurse finds that the breasts feel nodular. The patient does not complain of any pain. What does the nurse deduce from these findings?
normal finding, changes occur during pregnancy
When teaching the breast self-examination, you would inform the woman that the best time to conduct breast self-examination is:
on the 4th to 7th day of cycle
Peau d'orange
orange peel appearance of breast due to edema
mastalgia
pain in the breast, can occur with trauma, infection, inflammation and benign breast disease
galactorrhea
persistent white discharge of milk between nursing sessions or after weaning
bimanual technique
preferred for women with pendulous breasts
paget disease
rare form of breast cancer
Montgomery glands
sebaceous glands in the areola that secrete protective lipid during lactation, located in the areola
Intraductal papilloma
serosanguineous nipple discharge
best position to inspect breasts for retraction
sitting with hands pushing onto hips
alveoli
smallest structures in the mammary gland
invasive breast cancer
solid, hard, dense and fixed to underlying tissues or skin
Paget's disease
starts with a small crust on the nipple apex and spreads to the areola. It is also associated with abnormal nipple discharge
cooper ligaments
suspensory ligaments; fibrous bands extending from the inner breast surface to the chest wall muscles
Ectasia of the breast
the mammary ducts are lesions or infections that lead to nipple discharge.
colostrum
thin, yellow fluid, precursor of milk, secreted for a few days after birth
The nurse takes special care while checking a patient's tail of Spence. What is the reason for this intervention?
to detect breast cancer
most common site for breast tumors
upper outer quadrant
pendulous breasts
when the nipple and the lower breast mass are below the breast crease line on the chest.
