Breast and Lymph Nodes

Subjective Data Questions for Rash

appearance, onset, location

Subjective Question topics

1. trauma to breasts

2. history of cancer

3. breast disease?

4. swelling or rash?

5. lump or discharge?

6. surgery

7. radiation

8. medications

When can screening mammography begin?

Ages 40-44

When can annual mammography begin?

Ages 45-54

When can biennial mammography begin?

Over age 55 or continuation of annual

How do you prep for CBE?

1. woman sits up facing the examiner

2. use a gown to cover them as they prefer (can put it on backwards)

3. look at both for symmetry

4. use a ruler, pen, and small pillow

What is common/ok in appearance of breasts?

A slight asymmetry

What is galactorrhea?

white milky discharge during pregnancy and breastfeeding up to one year after weaning (definitely not normal with younger individuals)

What are the patterns commonly used for palpating the breasts?

• vertical strip pattern

• from the nipple palpating out to periphery as if following spokes on a wheel

• palpating in concentric circles out to periphery

What do a Pt breat feel like after pregnancy?

The tissue feels softer and looser

How to describe location of lump or mass?

as with clock face, describe distance in centimeters from nipple; or diagram breasts in woman’s record and mark in location of lump

How to judge Size of Lump or Mass?

Judge in centimeters in three dimensions: width, length and thickness

Shape of Lump or Mass

state whether lump is oval, round, lobulated, or indistinct

consistency of lump or mass

state whether lump is soft, firm, or hard

Movable lump or mass

Is lump freely movable or fixed when you try to slide it over chest wall?

bad sign if it isn’t movable

Distinctness of lump or mass

is lump solitary or multiple?

Lymphadenopathy of lump or mass

are any regional lymph nodes palpable?

Steps of Breast Self- Examination

1. lie down

2. press the 3 middle fingers in a ciruclar motion

3. use 3 levels of pressure

4. follow and up and down pattern

5. sit up

6. examine underarm with arm slightly rasied

7. note surface changes with hands pushed on hips and shoulders hunched

Tips for a good BSE

1. palpation in shower easier

2. keep teaching simple

3. monitor proper palpation

4. pamphlets for Pt

Examining women with a healed mastectomy

1. return of cancer can occur, be aware

2. inspect incisional site, anterior chest, and healing stage

3. palpate breast first

4. palpate axilla and ROM

5. compare bilaterally

What is gynecomastia in men?

• benign growth of breast tissue

• feels like smooth, firm, movable disk

• occurs during puberty commonly and is temporary

What happens to pregnant women’s breasts?

• breasts increase in size, as do nipples

• nipples darker

• vascular changes occur

What happens to lactating women’s breasts?

• colostrum changes to milk production around the third postpartum day

• nipple soreness occurs

• breast engorgement occurs

What happens to an aging woman’s breasts?

• flat

• saggy

• gravity takes them down

• reinforce value of BSE and mammography

• age over 50 increase risk of cancer

normal lymph characteristics

• small

• round

• pea sized

• non-palpable in healthy Pt

normal lymph function

drainage of the body

How to palpate axilla?

Reach fingers high into the axilla and move them firmly down to four directions

Define normal characteristics of lymph nodes and how they
differ from abnormal lymph nodes in terms of size, texture, and
palpability. Provide examples of subjective data questions related to axillary lymph nodes

Normal lymph nodes are small, round, pea-sized structures that
are typically non-palpable in a healthy individual. Abnormal
lymph nodes may be enlarged, firm, tender, and palpable.
Subjective data questions related to axillary lymph nodes may
include asking about any pain, tenderness, or swelling in the
axillary area

Discuss the significance of irregular axillary lymph nodes,
highlighting their characteristics such as enlargement,
tenderness, and palpability. How might these factors indicate
underlying health issues?

Irregular axillary lymph nodes, characterized by enlargement,
tenderness, and usually being non-palpable, can indicate
potential health issues such as infection or malignancy. These
characteristics may prompt further investigation to determine
the underlying cause.

Explain the importance of inspecting the axillary and
supraclavicular regions during breast examination. What
abnormalities should be noted, and what might they suggest
about lymphatic drainage or potential pathology?

Inspecting the axillary and supraclavicular regions during
breast examination is important to assess for any abnormalities
such as bulging, discoloration, or edema, which could suggest
compromised lymphatic drainage or underlying pathology such
as breast cancer metastasis

Describe the procedure for inspecting and palpating the axillae
during a breast examination. What specific characteristics should be assessed, and how might they indicate abnormalities in lymph nodes?

During axillary inspection and palpation, it's crucial to assess for
any abnormalities such as enlarged lymph nodes, tenderness, or masses. Palpation should be systematic, covering the entire
axillary area to detect any irregularities in size, texture, or mobility of lymph nodes

Discuss the characteristics of a lump or mass in the breast that
could indicate lymphadenopathy. What features should be noted based on location, size, shape, consistency, and mobility?

A lump or mass in the breast may indicate lymphadenopathy if
it is palpable and associated with enlarged lymph nodes.
Characteristics to note include location in relation to the nipple,
size, shape, consistency (e.g., firmness), and mobility. Enlarged lymph nodes may be palpable in the axillary or supraclavicular
regions.

Compare and contrast normal and abnormal characteristics of
inguinal lymph nodes. How might enlarged, hard, matted, and
fixed nodes differ from the normal size, texture, and mobility of
inguinal lymph nodes?

Normal inguinal lymph nodes are typically small (around 1 cm),
soft, discrete, and movable. Abnormal nodes may be enlarged,
hard, matted, and fixed, which could indicate underlying
pathology such as infection or cancer.

Explain why it's important to note any regions of swelling on
the breast, axillary, and inguinal lymph nodes during
examination. What could these regions indicate about lymphatic
function or potential health issues?

Swelling in the breast, axillary, or inguinal lymph nodes may
indicate issues with lymphatic drainage or underlying health
problems such as infection, inflammation, or malignancy. It's
important to note any regions of swelling during the examination
to guide further evaluation and management.