BREAST ASSESSMENT

Breast • to identify breast disease

-important role in modern culture
• to initiate early treatment
-viewed as measures of sexuality
-secondary sex characteristics Advantages:
-physiologic fiction: milk secretion to feed infants
• When they perform BSE properly and regularl, they can
note the changes in their breasts and seek further
Clinical Value of Breast
evaluation.
-90% of breast cancer are found by women themselves
-women discover lumps at early stage; surgery can save • Examination should be done every month at the end of
every menses in all menstruating women.
70-80% of proven cases

Anatomy and Physiology Barrier: Lack of confidence

-lies against the anterior thoracic wall
-extending from the clavicle and 2nd rib down to the 6th POSITION OF THE CLIENT
rib, from the sternum across the mid-axillary line • UPRIGHT POSITION
-surface: generally rectangular • SUPINE/STANDING
-overlies: pectoralis major
-divided in 4 quadrants PERFECT TIME FOR BSE:
-5-7 days after menstruation between the 4th or 7th day of
the cycle (if the cycle is regular)

SUBJECTIVE DATA COLLECTION

URGENT ASSESSMENT
•Newly discovered lump, pain nipple discharge.

•CURRENT HEALTH HISTORY

•Breast discomfort, masses or lumps, nipple discharge
-axillary tail of breast tissue extends toward anterior •History of previous breast disease, (+) result for breast
axillary fold cancer antigen
•Breast surgeries including aesthetic procedures such as
TISSUE: augmentation
• Glandular tissue-secretory tubualveolar ducts, •Menstruation, pregnancy and lactation history
•Hormone replacement therapy, contraceptive use
• lobules- drains into the nipples or Arreola
•Personal history of breast trauma and self care behaviors.
• Fibrous connective tissue- support
• Adipose tissue- carries with age, the general state of •PAST MEDICAL HISTORY
nutrition, pregnancy, exogenous hormone use, and other •Dx with cancer, what kind, treatment, breast surgery,
factor. infection, last menstrual period, pregnant and gave birth,
breastfeed. (how many months).
AREOLA AND NIPPLE:
-surface has small, rounded elevations •LIFESTYLE AND PERSONAL HABITS
-well supplied with smooth muscle •Jog or run, wear sports bra, drink alcohol (how often, how
-supernumerary nipples are located along the ‘milk line’ much), smoking, overweight, breast examination, had
undergone mammogram, ultrasound or MRI.
LYMPHATICS:
• Central node - most palpable •MEDICATIONS
Seldom palpable nodes: •What meds (RX/OTC), dose, supplements.
• PECTORAL NODES: anterior
• SUB-SCAPULAR NODES: posterior •FAMILY HISTORY
• LATERAL NODES: located along the upper humerus
COMMON BREAST AND AXILLARY SYMPTOMS
BREAST SELF EXAMINATION Breast pain, Rash, Lumps, Swelling, Nipple Discharge,
Importance: Trauma

HEALTH ASSESSMENT FINALS / AD

 BREAST ASSESSMENT
OBJECTIVE DATA COLLECTION 6.Ductogram – examination of the breast ducts to
FEMALE BREAST determine causes of unilateral, single pore nipple
discharge.
•INSPECTION 7.Cytological smear – smearing and staining a cell
•While sitting with arms at the sides; skin appearance- sample (breast discharge) to determine cause.
color & texture, size and shape, symmetry, contour 8.TSH – to determine whether nipple discharge is
•Nipple areola characteristics secondary to a thyroid problem.

•PALPATION DESIRED PATIENT OUTCOMES

•Patient looks at and touches changed or missing body
•While sitting; palpate the supraclavicular & intraclavicular part.
areas for lymph nodes, nodules. (vertical, circular or wedge •Patient returns to previous social involvement.
pattern). •Patient verbalizes increased self- acceptance through
•Nipple for discharges positive self-statements.
•Patient seeks health care for breast lumps or masses.
MALE BREASTS SOME NURSING INTERVENTIONS
•Assess risk factors for breast cancer.
•INSPECTION •Allow for privacy when examining breast tissue.
•Place pillow or towel under shoulder to increase comfort
•Swelling, ulceration or drainage during examination.
•Provide a mirror for the patient to visualize abnormal
•PALPATION tissue and incisions.
•Nodules and masses
COMMON NURSING DIAGNOSIS ASSOCIATED FOR
BREAST CANCER
ADDITIONAL TECHNIQUES
•Bimanual techniques – for pendulous breast Disturbed body image
•Transillumination – to differentiate between a solid and Ineffective coping
fluid filled mass. Ineffective role performance
Grieving

LABORATORY AND DIAGNOSTIC TESTING BREAST ABNORMALITIES

1.Mammography – low dose x-ray of the breast to
diagnose breast disease.
2.Ultrasound – non invasive using high frequency sound
waves to differentiate between a solid and cystic mass.
•PAGET’S DISEASE OF THE NIPPLE - is a rare form of
breast cancer in which cancer cells collect in or around the
nipple. The cancer usually affects the ducts of the nipple
first (small milk-carrying tubes), then spreads to the nipple
surface and the areola.

3.MRI – uses magnetic fields, radio waves and computer to •BREAST CARCINOMA - originating in the milk ducts
detect breast cancer stage. and/or lobules (glandular tissue) of the breast.

•MASTITIS - inflammation of breast tissue that sometimes

4.Biopsy- is a medical test involving removal of cells or involves an infection. The inflammation results in breast
tissues for examination. pain, swelling, warmth and redness.

2 TYPES OF BIOPSY •GYNECOMASTIA - enlargement or swelling of breast

a) Aspiration Biopsy – a syringe and g 18 needle is used to
aspirate tissue from the site which is under local
anesthesia.
-The specimen is spread on a glass slide, fixed, stained
and sent to the laboratory
tissue in males. It is most commonly caused by male
estrogen levels that are too high or are out of balance with
testosterone levels.
•MASTECTOMY - surgical removal of one or both breasts,
partially or completely.

b.) Incisional Biopsy – a piece of tissue is obtained in the

operating room, sent to the laboratory fro frozen section
which is the stained and examined under the microscope.
5.Microscopy – viewing cells under a microscope to
enhance cellular features.

HEALTH ASSESSMENT FINALS / AD