HA Breasts, Axilla

Internal anatomy of breasts (Not important; just good to know

• Glandular tissue

• Fibrous tissue

• Adipose tissue

Breasts are known as

mammary glands

Position of the breasts

Lies anterior to pectoral is major & serratus anterior muscles

Location of the breasts

Between the 2nd and 6th ribs, extends from side of sternum to midaxillary line

External breast structures

• Tail of spence

• Nipple

• Areola

Tail of spence

• superior lateral corner of breast tissue that projects up and laterally into the axilla

Nipple

• center of breast

• round with tiny milk duct openings

Areola

surrounds nipple 1-2cm in radius

Internal anatomy of breast consist of

• Glandular tissue

• Fibrous tissue

• Adipose tissue

Glandular tissue

• 15-20 lobes radiating from nipple

• lobes consist of lobules that have clusters of alveoli that produce milk

Fibrous tissue

• Cooper ligaments

• Fibrous connective tissue that support the breast tissue

Adipose tissue

fatty tissue that constitutes the bulk of the breast

When do the development of breasts begin?

during fetal development

supernumerary nipple

extra nipple visible along mammary ridge

When the adolescent goes through puberty, what stimulates breast development?

the hormone estrogen

Breast development in pregnancy characteristics

• ductal system & fatty tissue expand

• breasts enlarge + more nodular

• nipples & areola are larger, darker in color, nipples not eerectile, tubercles more prominent, colostrum present, vein network visible

what happens to breast size in menopause?

they decrease

Male breast characteristics

• consists of a thin disk with undeveloped tissue underlying the nipple

• areola: well developed

Gynecomastia

• breast enlargement

• can be noted during adolescence

Subjective data of patient history & assessment

• collecting information

  • pain: mastalgia (harmless pain)

  • lump

  • discharge

  • rash

  • swelling

  • trauma

  • h/o breast disease

  • surgery or radiation

  • medication: oral contraceptives

  • last mammogram

Your patient states that they have pain/mastalgia in their breast. What should the nurse do?

Reassure them that pain in the breast is normal and does not indicate malignancy

Breast self- examination

• #1: Examine your breasts in the shower

• #2: Examine your breasts in the mirror w/ your arms down, up, and on your hips

• #3: Stand and press your fingers on your breast, working around the breast in a circular direction

• #4: Lay down → repeat step 3

• $5: Squeeze nipples; check for discharge. Check under the nipple last

Preparation for breast assessment

• explain procedure to client

• position supine or sitting upright

• have client elevate the hand to under/back of the head when examining breast

• inspect prior to palpating

Abnormal conditions of the breast

• Lump that is fixed, cannot move

• Asymmetry of breasts

• dimpling (punckering/denting/tethering of skin)

• edema (peau d’orange)

• fixation

• nipple deviation

• abnormal nipples discharge

• breast abscess & mastitis

Normal findings of the breast assessment

• symmetry of breasts

• location of breasts

• intact skin

• location of nipples

Normal findings of female external genitalia

• inspect: skin color, no lesions, no discharge

• Pubic hair to mons pubis

• Labia major plump, part to inspect labia movies

• Clitoris: located @ the top of the bunks

• Urethral opening appears slit-like, midline appearance

• vaginal opening/introitus: vertical slit, larger opening

• Perineum smooth, muscle tone- tight

• Anus: course skin

Normal findings of female internal genitalia

• cervix: pink, no lesions on inspection (speculum, midline)

• uterus: central, normal position, no pain

• Ascend normal size

GU Changes in infants

• estrogen allows for engorged genitalia in newborns

GU Changes in adolescents

secondary sex characteristics

GU Changes in pregnancy

• several changes

• uterus will become abdominal organ

GU changes of aging woman

decrease in estrogen leads to decline in GU organs

Subjective data/health history of female GU system

• menstrual and/or menstrual history

• obstetric history

• pelvic pain

• urinary symptoms

• vaginal discharge

• past medical history

• family history

• sexual history/contraceptive use

• STI

physical examination for female GU system

• establish trusting relationship w/ pt

• inform client of procedure

• position patient; lithotomy

• equipment needed: nonsterile gloves + speculum + lubricant + cotton tip for blotting

Abnormal findings of female external genitalia

• Labia: genital warts, nits/lice, lesions, rashes

• Discharge: sign of infection

• swelling, pain, tenderness

• bleeding: grains, infection

• thin perineum

Abnormal findings of female internal genitalia

• Uterus: enlarged, bulging, prolapsed, mass

• Samina’s: mass

• Cervix: lesions, inflammation

• Pain on examination

Primary syphillis

a small superficial ulcer with a yellowish serous discharge

Secondary syphillis

• a small superficial ulcer w/ yellowish serous discharge that RESOLVES spontaneously

• progresses to symptoms of fever, lymphadenopathy, mucocutaneous red rash, sore throat

Chlamydia/Gonorrhea

• STI that has

  • minimal/no symptoms, urinary frequency, dysuria, vaginal discharge, postnuptial bleeding

• screening: urine samir. cervical/vaginal swab

• Tx: antibiotics, retest 3-6 months

• education

Human Papillomavirus

• painless, warty growths

• described as

  • Pink/flesh-colored

  • soft, pointed, moist, warty papules

  • single or multiple-like in a cauliflower-like patch

  • occur around nicks, introitus, anus, vagina, cervix

Pelvic inflammatory disease

Inflammatory process of microorganisms in the cervix & vagina ascending to the endometrium and fallopian tubes

pelvic inflammatory disease s/s

• vaginal discharge

• dysuria

• abnormal uterine bleeding

• abscess in Bartholin or Skene glands

• acute salpingitis

Labia majora

Two rounded folds of fatty tissue covering skin downward & backwards from mons pubis

Skene’s duct

Produced secretions that lubricate urethral opening

Fallopian tubes

Attached to uterus and carries fertilized ovum

mons pubis

fatty pad over anterior surface of symphysis pubis

Uterus

pear shaped organ in pelvis that is thick-walled & muscular

cystocele

bladder prolapses into the vagina from weakened anterior pelvic muscles

cystocele s/s

pressure in vagina, stress incontinence

Rectocele

part of the rectum prolapses into the vagina from posterior tissue weakness

Rectocele s/s

Feeling of pressure in vagina, possibly constipation

Uterine prolapse

• uterus protrudes in the vagina

• feeling of pelvic pressure

Cervical cancer

cervix ulcer

cervical cancer risk factors

• infection

• first intercourse @ early age

• multiple sex partners

• cigarette smoking

• undetected HPV

• diagnosis: pap test and biopsy

endometrial cancer

abnormal and intermenstrual bleeding before menopause

• postmenopausal bleed

Ovarian cancer s/s

vague symptoms

• abdominal pain

• pelvic/back pain

• increased abdominal size

• bloating