Assessing the Breasts and Regional nodes client has ever had a clinical breast exam previously.

t has ever had a clinical breast exam previously. Discuss how the results
will be used in planning further care or treatments.
BREAST AND AXILLAE  “Introduce; verify; Nice to meet you (name) so today I’ll be performing
breast examination, have you ever had one of this before? No, okay so
-The breasts of men and women need to
what this examination will involve is me having a look in your breast
be inspected and palpated. Men have
tissue and regional nodes. It is necessary to detect if there is any sign of
some glandular tissue beneath each
breast disease and initiate early treatment as possible. During the
nipple, whereas mature women have
examination it is needed to expose the breast and I need you to
glandular tissue throughout the breast.
participate well by following the instructions that been told. Is that okay
- In females, the largest portion of with you?”
glandular breast tissue is located in the 2. Perform hand hygiene and observe other appropriate infection prevention
upper outer quadrant of each breast. A procedures.
projection of breast tissue from this 3. Provide for client privacy.
quadrant extends into the axilla, called the 4. Inquire if the client has any history and if the client performs breast self-
axillary tail of Spence where majority of examination
breast tumors are located  breast masses
 pain or tenderness related to menstrual cycle
- Skills: the nurse can localize specific findings by dividing the breast into
 discharge from the nipple
quadrants and the axillary tail.
 medication history
Purpose: to identify signs of breast disease and then to initiate early
treatment Assessment: Breasts
Procedure Normal Findings Abnormal Findings
Preparation: 5. Inspection. Inspect Females: rounded shape; Recent change in breast size;
- Have the client sits in an upright position during inspection of breast and the breasts for size, slightly unequal in size; swellings; marked asymmetry
palpation of regional nodes symmetry, and generally symmetric
contour or shape Males: breasts even with
- The client assumes a supine position during palpation of breast while the client is in a the chest wall; if obese,
Equipment: sitting position. may be similar in shape to
 Centimeter ruler Tip: Tell or explain to the client every procedure female breasts
performed especially before palpating always let Figure 1 Retraction Figure 2 Orange Peel
 Small pillow the client aware of it first.
 Gloves
Implementation:
1. Prior to performing the procedure, introduce self and verify the client’s
identity using agency protocol. Explain to the client what you are going to do, Figure 3
why it is necessary, and how he or she can participate. Inquire whether the Lesion
causing
retraction of
the skin
6. Inspect the skin of - Skin uniform in color - Localized discharge, and same direction (out in crusts, or cracks
the breast for (similar to skin of discolorations or lesions. young women and - Recent inversion of
localized abdomen if not hyperpigmentation men, downward in one or both nipples
discolorations or tanned) - Retraction or dimpling older women) that was previously
- No discharge, except
hyperpigmentation, - Skin smooth and - Unilateral, localized everted
from pregnant or
retraction or intact hyper vascular areas breast-feeding females
dimpling, localized - Diffuse symmetric (associated with - Inversion of one or
hypervascular areas horizontal or vertical increased blood flow) both nipples that is
( visibility and vascular pattern in - Swelling or edema Figure 7 Inverted nipple
present from puberty
pattern of breast light-skinned people appearing as pig skin 10. Palpate the axillary, - No tenderness, - tenderness, masses or
veins), swelling or - Striae (stretch or orange peel due to subclavicular, and masses or nodules nodules
edema. marks); moles and exaggeration of the supraclavicular
nevi pores lymph nodes
7. Emphasize any - Rise symmetrically - Retraction or dimpling
retraction by having with no signs of Figure 5 Tip: Demonstrate it Palpation of Axillary Nodes:
the client: retraction to the client while instructing
• Raise the arms him/her While the client sits with the arms abducted and
above the head. supported on the nurse’s forearm. Use the flat
•Push the hands surfaces of all fingertips to palpate the four areas
together, with
of the axilla, use the thumb as a support:
elbows flexed. Figure 4 b. and c.
make retraction
• Press the hands more visible; These
down on the hips. actions contract the  The edge of the greater pectoral
pectoral muscles
muscle (musculus pectoralis major)
along the anterior axillary line
8. Inspect the areola - Round or oval and - Any asymmetry, mass, or
 The thoracic wall in the midaxillary
area for size, shape, bilaterally the same lesion
symmetry, color, - Color varies widely, area
surface chara- from light pink to dark  The upper part of the humerus
cteristics, and any brown  The anterior edge of the latissimus
masses or lesions. - Irregular placement of dorsi muscle along the posterior
sebaceous glands on
axillary line.
the surface of the
areola (Montgomery’s 
tubercles) are present Figure 6 Montgomery's tubercles

9. Inspect the nipples - Round, everted, and - Asymmetrical size and

for size, shape, equal in size; similar in color
position, color, color; soft and smooth; - Presence of discharge,
both nipples point in
 Before Palpating:
Palpation Inform
of the breast is performed while the client is supine. Rationale:
the client.
In the
“What I need to supine
do nowposition,
is have tothefeel
breasts flatten evenly against the chest wall,
the glandsfacilitating palpation
in your armpit, let me take

all the weight of your is
Sitting position alsosorecommended
arm just for clients with pendulous breast or
history ofPalpation:
relax.” During breast masses. Small
 motions
Circular To enhance areflattening
made of the breast, instruct the client to abduct the arm
while
and
pressing firmly place her hand behind her head. Then place a small pillow or rolled
towel under the client’s shoulder.
PALPATION
11. Palpate the breast for - No tenderness, -  Use the palmar surface of
masses, tenderness, and any masses or the middle three fingertips
discharge from the nipples. nodules (held together) and make a
gentle rotary motion on the breast.
 If the client reports a breast lump, start with the “normal” breast to obtain
12. Palpate the areolae and the - No tenderness, -
nipples for masses. Compress
baseline data that will serve as a comparison to the reportedly involved
masses, nodules,
each nipple to determine the breast.
or nipple
presence of any discharge. If dis- discharge  Choose one of three patterns for
charge is present, milk the palpation:
breast along its radius to identify a. Hands-of-the-clock or
the dischargeproducing lobe.
spokeson-a-wheel
Assess any discharge for “Could you lie down for me andb.justConcentric circles
amount, color, consistency, and
put your right hand behind c.yourVertical strips pattern.
odor. Note also any tenderness
on palpation. head. Now I’m going to palpate
 your
Start at one point for palpation, and move
breast, let me know if there aresystematically
any to the end point to ensure that
areas that are painful.” all breast surfaces are assessed.
13. If the client wishes, teach the -
technique of breast self-  Pay particular attention to the upper outer
examination quadrant area and the tail of Spence.
ASSESSMENT
14. Document findings in the client
record using printed or
 If you detect a mass, record the following data:
electronic forms or checklists a. Location: relative to the quadrants and axillary tail, or the clock and the
supplemented by narrative distance from the nipple in centimeters.
notes when appropriate. b. Size: the length, width, and thickness of the mass in centimeters. If you are
able to determine the discrete edges, record this fact.
Palpation of Breast: c. Shape: whether the mass is round, oval, lobulated, indistinct, or irregular.
POSSITIONING d. Consistency: whether the mass is hard or soft.
 e. Mobility: whether the mass is movable or fixed.
f. Skin over the lump: whether it is reddened, dimpled, or retracted.
g. Nipple: whether it is displaced or retracted.
h. Tenderness: whether palpation is painful.

Palpation of Nipple:

Figure 8 If discharge is present

compress along it's radius to
identify the discharge producing
lobe

Figure 9 Compress using the

thumb and index finger