Breast and Genitalia

Breast Lymphatics

  • Extensive lymphatic drainage system:

    • Four groups of axillary nodes:

    • Central axillary nodes

    • Pectoral (anterior)

    • Subscapular (posterior)

    • Lateral

  • From central axillary nodes, drainage flows to infraclavicular and supraclavicular nodes.

Regional Lymphatics Flow

  • Illustration indicates the direction of lymphatic flow:

    • Interpectoral (Rotter)

    • Supraclavicular

    • Infraclavicular

    • Lateral Axillary

    • Central Axillary

    • Subscapular (posterior axillary)

    • Pectoral (anterior axillary)

  • Parasternal (internal thoracic): Flow to opposite breast and toward subdiaphragmatic nodes and liver.

Inspection and Palpation of the Axillae

  • Examine while patient is sitting:

    • Nodes should typically be non-palpable; small, non-tender nodes may be felt in the central group.

    • Note any enlarged/tender lymph nodes.

Characteristics of Lump or Mass

  • Lymphadenopathy: Check if regional lymph nodes are palpable.

Summary Checklist for Breasts and Regional Lymphatics

  • Palpate axillae and regional lymph nodes.

Summary Checklist for Male Genitourinary Assessment

  • Palpate the inguinal lymph nodes.

Menopause
Developmental Competence: Aging Woman (Breasts)

  • Menopause: Marks the end of menstrual cycles.

  • Symptoms include:

    • Decrease in vaginal secretions

    • Atrophy

    • Hot flashes

    • Mood swings

  • Post-menopause, decreased secretion of estrogen/progesterone leads to atrophy of breast tissue.

Developmental Competence: Aging Woman (Female Genitourinary)

  • Female hormonal changes occur rapidly compared to males.

    • Menopause: Cessation of menstruation.

    • Aging leads to drooping uterus and vaginal atrophy.

Testicular and Breast Self-Exams
Teaching Breast Self-Examination (BSE)

  • Instructions:

    • Lie down, use 3 middle fingers in a circular motion at varying pressures, following an up-and-down pattern.

    • Sit up to examine the underarm with the arm slightly raised and note surface changes while changing positions.

  • Keep Teaching Simple: Teach women to perform in front of a mirror disrobed to the waist and to use the shower for easier palpation.

  • Provide models for demonstrations and supplemental pamphlets for guidance.

Developmental Competence: Adolescent Girls

  • Adolescent girls: Breast development typically occurs between ages 8 and 10; teach BSE at this stage.

Self-Care: Testicular Self-Examination (TSE)

  • Encourage self-examination from ages 13-14 onward:

    • T**: Timing (once a month)

    • S**: Shower (warm water relaxes the scrotum)

    • E**: Examine (check for changes and report them immediately).

Summary Checklist for Breasts and Regional Lymphatics

  • Teach BSE practices to patients.

Breast Cancer Risk Factors
Culture and Genetics: Breast Cancer

  • Review of breast cancer statistics regarding:

    • Morbidity, mortality, and prognosis.

  • BRCA1 and BRCA2 mutations: Critical genetic risk factors.

  • Survival rates vary based on the stage of diagnosis.

  • Lifestyle risk factors:

    • Dose-dependent effect of alcohol consumption.

    • Postmenopausal weight gain.

    • Decreased physical activity.

Risk Profile for Breast Cancer

  • Risk Factors:

    • First-degree relative with breast cancer (mother, sister, daughter).

    • Prolonged use of hormones ( > 5 years).

    • Early menstruation (before age 12).

    • Late menopause (after age 55).

Developmental Competence: Aging Woman (Breasts)

  • Reinforce the importance of regular BSE for women over 50, who are at an increased risk of breast cancer.

Prostate
Anatomy of the Prostate Gland

  • The prostate gland lies anterior to the rectum: smooth, elastic, rubbery structure. Should NOT feel firm.

    • Produces a fluid rich in fructose which nourishes sperm and contains prostaglandins.

Developmental Competence: Children and Adults (Rectum and Anal Canal)

  • The prostate gland often enlarges during middle adulthood, with benign prostatic hypertrophy (BPH) observed in 80% of men over the age of 60.

Culture and Genetics: Prostate Cancer

  • Most frequently diagnosed cancer in men, with risk factors including age, African ancestry, family history, and genetic mutations (BRCA1/BRCA2).

  • Ethnic/geographic variations indicate higher incidence and mortality rates for African American men, contributing factors include diets rich in red meat/high-fat dairy and obesity.

Health Promotion Teaching for Prostate and Colorectal Cancer

  • PSA screening recommended, effective early detection method.

Summary Checklist: Anus, Rectum, and Prostate

  • Conduct prostate assessments and test stool for occult blood.

Health History
Subjective Data for Breast Assessment

Questions: Breast

  • Symptoms:

    • Pain, lump, discharge.

    • Rash, swelling, trauma.

    • History of breast disease, surgery, or radiation.

    • Current medications.

  • Promote patient-centered care:

    • Perform breast self-examination (SBE) and inquire about the last mammogram.

Questions: Axilla

  • Symptoms:

    • Tenderness, lump, or swelling.

    • Rash.

Subjective Data for Female Genitourinary Assessment

  • Data includes:

    • Menstrual history, obstetric history, menopause, acute pelvic pain, urinary symptoms, vaginal discharge, sexual activity, contraceptive use, and STI contacts.

Patient-Centered Care Questions

  • Inquire about frequency of gynecologic checkups and compliance with recommended screenings.

  • Discuss last Pap smear results and yearly STI screenings (specifically for chlamydia).

Subjective Data for Male Genitourinary Assessment

  • Include frequency, urgency, nocturia, dysuria, hesitancy, straining, penile pain/lesions/discharge, self-care behaviors for the scrotum, sexual history, and STI contact.

Subjective Data for Rectal Assessment

  • Include usual bowel routine, changes in bowel habits, rectal symptoms (e.g., bleeding, medications affecting bowel function), and family history.