NCMA 121: HEALTH ASSESSMENT 2ND

ASSESSMENT OF BREAST AND

LYMPHATIC SYSTEM
SEMESTER
APRIL
AY 2021-2022
11
MIDTERMS LECTURER: MA’AM CORA P. QUINTO 1ST YEAR NURSING

WEEK 11: ASSESSMENT OF BREAST AND LYMPHATIC

SYSTEM

TOPIC
SUBTOPIC
SUB-SUBTOPIC

ASSESSMENT OF THE BREAST AND LYMPHATIC Lymph Nodes

SYSTEM

The Breast Anatomy OTHER BREAST STRUCTURES:

Muscles That Supports

Breast

Lymphatic Drainage
of the Breast

Supernumerary
Nipples

Breast Quadrants

● The Upper Outer Quadrant Is the Area Most Targeted By

Breast Cancer

● is an additional nipple
● minor birth defect
● nonfunctional, without accompanying mammary glands
● similar to the location of nipples on mammals that have
multiple nipples along the underbelly
 BREAST ○ into them drain channels from three other groups of
● A pair of mammary glands located on the anterior chest lymph nodes, which are seldom palpable
wall ▪ Pectoral Nodes (anterior)
● The milk-producing gland of women - located along the lower border of the
● Anatomic Breast Landmarks And Their Position In The pectoralis major inside the anterior axillary
Thorax fold
○ extending vertically from the 2nd to the 6th rib and ▪ Subscapular Nodes (posterior)
laterally from the sternal border to the axilla - located along the lower border of the
● How do breasts change with age? pectoralis major inside the anterior axillary
○ Occurs between ages 8-13 (during puberty because fold
of the stimulation of estrogen, especially for females) ▪ Lateral Nodes (brachial)
○ Breast and nipple as a single mound - located along the upper humerus
○ Tender and full During the reproductive years ● General Approach to Breast Assessment
○ During pregnancy – pigmentation and enlargement ○ Prior Assessment
○ Darkening of nipples and areola during pregnancy ▪ preparation of the nurse
○ Corpus luteum and placenta – can cause breast - when to wear gloves
soreness during pregnancy ▪ preparation of the patient
○ Glandular tissue atrophy during menopause because - it is best not to use creams, lotions or
of hormonal changes powders nor shave her underarms 24 to 48
○ Gradual decline of tissues on the mammary glands hours before examination
during menopause ▪ explain the procedure: what, how and why
▪ adopt a non-judgmental and supportive approach
● Male Concerns ▪ be aware of the impact of culture on breast
○ Composed of a well-developed assessment and breast self examination
areola and small nipple that has ○ Positioning
immature tissue underneath ▪ Performed when assessing the breast for
○ Gynecomastia (describes the retraction and dimpling (retraction and dimpling
enlargement of male breast tissue is caused by malignant tumor attached to the
and may occur normally in breast tissue and fascia of the muscle)
adolescent and in elderly male) ▪ The following actions contract the pectoral
● Nipples muscles
○ Round, hairless pigmented - Presses the hands together with the fingers
protrusion of erectile tissue of one hand pointing opposite to the fingers
approximately 0.5 to 1.5 in of the other hand
diameter
○ Located at the center of the
breast
○ Lactiferous ducts
▪ There are 12 to 20
minute openings on the
surface of the nipple
● Areola
○ A pigmented area surrounding the nipples - Arms raised over client’s head
approximately 2.5 to 10cm in diameter
○ Montgomery's tubercle
▪ Appears rough because it contains modified
sebaceous (oil) glands
▪ Helps lubricate the nipple, lactation
● Axilla
○ The small hollow portion beneath the arm where it
joins the body at the shoulders
○ Also called the armpit - Arms lowered on client’s sides
● Functions Of The Breasts
○ Synthesis, secretion and ejection of milk for the
nourishment and protection of neonates and infants
○ Breastfeeding
○ Provides sensual pleasure during sexual foreplay
○ Provides some protection on the anterior chest wall

LYMPHATICS / REGIONAL NODES

● Central Nodes - Hands pressed against client’s hips
○ most frequently palpable of the
axillary lymph nodes
○ lie along the chest wall, usually
high in the axilla and midway
between the anterior and
posterior axillary folds
 - Lean forward ▪ are somewhat and pendulous
▪ may normally be larger than the other
▪ nipple inversion during puberty
▪ nipples point upward and laterally or outward or
downward
● CONTOUR
○ Normal
▪ the breast is normally convex, without flattening
▪ No retractions or dimpling
○ Deviations from normal
ASSESSMENT PROPER ▪ Retracted Nipple
INSPECTION - suggest malignancy
● COLOR
○ The breast and axilla are flesh-colored
○ Note for presence of moles – normal
○ Observe for the supernumerary nipple
○ Normal
▪ areolar areas and nipples are darker in
pigmentation
▪ terminal hairs on the areola
▪ color varies depending on the client’s skin tone ▪ Retracted Breast Tissue
▪ smooth texture, no lesions - suggest malignancy
▪ linear stretch marks may be seen during and
after pregnancy
○ Deviations from normal
▪ Redness
- associated with inflammation

▪ Dimpling
- suggest malignancy

▪ Peau d’orange
- pigskin-like or orange peel appearance
- due to edema
- due to blocked lymphatic drainage
- common to patients with edema and
metastatic breast diseases ● LESIONS OR MASSES
- Indication that there could be a blocked ○ Normal
lymphatic drainage ▪ breasts, areolas, nipples, axilla are free from
masses, tumors and primary and
secondary lesions
○ Deviations from normal
▪ Cancerous Tumors
- irregular, firm, hard
- not usually tender
- usually occur after age 50
- The most common symptom of
● VENOUS PATTERN / VASCULARITY breast cancer is a new lump or
○ Observe for visibility and pattern of breast veins mass
○ Normal
▪ normal superficial vascular patterns are diffuse
and symmetrical
▪ VEINS are more prominent during pregnancy ▪ Fibroadenomas
○ Deviations from normal - lobular, ovoid, round
▪ asymmetric venous pattern - firm, well-defined, seldom tender
▪ may be due to malignancy - singular and mobile
● THICKENING OR EDEMA - usually occur between puberty
○ Normal and menopause
▪ There should be no thickening or edema - noncancerous breast lumps
○ Deviations from normal
▪ Edematous
● SIZE AND SYMMETRY
○ Normal
▪ can be a variety of sizes
 ▪ Fibrocystic breast disease ○ Bimanual technique
(benign)
- round, elastic, defined, tender,
mobile cysts
- common from age 30 to
menopause

● DISCHARGE
○ Normal
▪ no discharge ○ Use the bimanual technique if the client has large
- nonpregnant, nonlactating clients breasts
▪ yellow discharge known as COLOSTRUM ○ Support the breast with your nondominant hand and
- white discharge of breast milk use your dominant hand to palpate
- rich in antibodies ● NOTE:
○ When assessing the breast think of the word DISC ○ Choose one that is most comfortable for you but be
▪ D – ischarge consistent and thorough with the method chosen
▪ I – nversion ○ All areas / angles / surfaces must be checked –
▪ S – kin changes palpated
▪ C – ompare with the other side ○ Be sure to palpate every square inch of the breast
from the nipple and areola to the periphery of the
PALPATION breast tissue and up into the tail of Spence
● Use finger pads of the 2nd, 3rd and 4th fingers, keeping ○ Vary the levels of pressure as you palpate
the fingers slightly flexed ▪ Light (if palpating superficial area of the breast)
▪ Medium (if palpating for mid-level tissues of the
breast)
▪ Firm (if palpating for an area near the ribs)
● Performed in Sequence
○ Supraclavicular and infraclavicular lymph node areas

● Patterns of Palpation
○ Circular or clockwise
○ Spiral or concentric circles

○ Breasts, with the patient in sitting position

▪ arms at side
▪ arms raised over head

○ Wedge or spokes of a wheel

○ Axillary lymph node regions

○ Vertical strip
○ Best validated technique in detecting breast mass
 ○ Breasts, with the patient in supine position INSPECTION AND PALPATION OF MALE BREAST
● Done essentially in the same manner as that of the female
breast
● Every month
● Every 1 – 3 years
● 1% of all breast cancer is found in men

EVALUATION OF BREAST MASS

● Note for the following:
○ Breast Lump
○ Demarcation
○ Mobility
○ Tenderness
○ Retraction

● Checking For Nipple Discharge

○ Steps
▪ Don gloves
▪ Compress the nipple using your thumb and index
finger to express any discharge
▪ Watch out for discharge appearing through one of
the duct openings on the nipple's surface (it is
best for you to get a sample of the specimen (the
specimen must be applied on a slide and send to
laboratory for assessment)
▪ Note the color, consistency and quantity of any
discharge and the exact location where it
appears
○ Normal
▪ nipple may become erect and the areola may
pucker in response to stimulation milky discharge
is usually normal only during pregnancy and
lactation
○ Deviations from Normal
▪ discharge may be seen in endocrine disorders
and with certain medications
▪ discharge from one breast may indicate
- benign intraductal papilloma
- fibrocystic disease
- cancer of the breast