MENNONITE COLLEGE OF NURSING AT ILLINOIS STATE UNIVERSITY Diagnostic Reasoning for Advanced Practice Nursing 431
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1 MENNONITE COLLEGE OF NURSING AT ILLINOIS STATE UNIVERSITY Diagnostic Reasoning for Advanced Practice Nursing 431 MODULE: BREASTS AND AXILLAE OBJECTIVES: Upon completion of this module, the student will be able to: 1. Identify the normal anatomical structures of the breast. 2. Describe abnormal findings. 3. Perform a complete breast and axillae examination incorporating techniques appropriate to the age of the client. 4. Demonstrate the instruction of breast self exam. REQUIRED READINGS: 1. Bates guide to physical examination and history taking, Chapter 10, The Breasts and Axillae. PRACTICE: Equipment needed: small pillow centimeter ruler
2 MODULE: BREASTS AND AXILLA STUDY QUESTIONS 1. Define or describe: h. areola i. acini j. Tubercles of Montgomery k. Cooper s ligaments l. Tail of Spence m. Colostrum n. Gynecomastia o. Mastitis p. Peau d Orange q. Supernumerary nipple r. fibroadenoma s. Intrraductal papilloma t. Paget s disease u. Striae 2. List the cardinal symptoms of breast disease. 3. What further history is important to obtain when evaluating a breast problem? 4. Identify or diagram the anatomy of the breast, axillary lymph nodes, and direction of lymph flow from the breast. 5. List the components of normal breast tissue. 6. Discuss the 5 stages of breast development (tanner stages) and their relationship to height and the development of secondary sexual characteristics: menarche, and public hair. 7. List 5 observable signs of breast cancer. 8. What maneuvers might be used to bring out or accentuate dimpling or retraction of the breast or nipples? 9. What are the steps in Breast self-exam? When should this exam be performed? 10. What changes in the breast normally occur with aging? 11. What changes in the breast normally occur with pregnancy? 12. Chart the exam of the normal breast. 13. List the risk factors for breast cancer.
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4 MODULE: BREASTS AND AXILLAE ASSESSMENT OF BREASTS AND AXILLA OVERVIEW A. Cardinal symptoms 1. pain or discomfort 2. masses 3. nipple deviation/discharge 4. swelling 5. more prominent venous pattern 6. skin changes *evaluate cyclic occurrence, changes over time, duration, lactation history B. Physical examination--key points 1. inspect/palpate in various positions: size, symmetry, contour skin: color/thickening/venous pattern nipples: size, shape, direction, lesion, discharge 2. Palpate in systematic fashion for consistency, tenderness, nodules, nipple elasticity,nodules, discharge, nodes C. Examples of findings: 1. nipples-supernumeraries, inversion, discharge, or galactorrhea 2. nipple erhthema, erosion-paget s disease, dermatitis, nipple fissure 3. tender masses/cysts, single or multiple--fibrocystic breasts 4. painless masses--fibroadeoma, cyst, carcinoma, TB 5. inflammatory masses--mastitis, abscess, inflammatory, CA 6. gynecomastia/mastitis/ carcinoma/fibroadenoma of male breast D. Changes with Aging The female breast shows evidence of the aging process. Axillary axis decreases, breast tissue and mammary glands atrophy and nipples may be inverted. The breasts tend to decrease in size and become more pendulous as glandular tissue atrophies, suspensory ligaments relax, and subcutaneous fat decreases. Subjective Complaint Objective Findings 1. decreased axillary hair 1. decreased axillary hair 2. nipple s turning in 2. inverted nipples 3. palpable breast mass 3. fibrotic and calcified, terminal breast 4. pendulous breasts ducts, easily palpated as linear strands
5 Diagnostic Reasoning for Advanced Practice Nursing 431 BREAST & AXILLARY EXAMINATION: STUDENT VALIDATION ** Branching Exam Procedure COMPONENT ACTIVITIES DONE NOT DONE FEMALE BREAST Inspection/Palpation (Client Sitting) 1. Inspect symmetry/color/surface characteristics of breasts (from front & sides) 2. Inspect skin 3. Inspect areola/nipples 4. Inspect with arms over head 5. Inspect with hands pressing at hips 6. **Observe breasts with patient leaning forward 7. Palpate breast with client sitting 8. Perform Axullary Exam: a. Inspect axillae b. Position client c. Palpate for central nodes d. Palpate for pectoral nodes e. Palpate for lateral nodes f. Palpate for subscapular nodes g. Palpate for supraclavicular nodes h. Palpate for infraclavicular nodes i. Repeat a-h on other side PALPATION (Patient Supine) 1. Position client 2. Palpate breast in systematic fashion 3. Palpate tail of breast 4. Palpate nipple, then compress 5. ** If discharge is present, palpate to locate lobe producing it 6. Repeat palpation sequence on other breast INSTRUCTION 1. Instruct client in BSE MALE BREAST 1. Inspect areola and nipple 2. Palpate breast tissue 3. Perform axillary exam (see above) COMMENTS
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