Breast and Axillae Assessment Notes

Introduction

• Importance of breast and axillae assessments in nursing practice:
  • Early detection of abnormalities can save lives.
  • Physical assessments incorporate inspection and palpation skills.

Breast Cancer Awareness

• Breast cancer affects both women and men.

Landmarks for Clinical Findings

• Use anatomical landmarks for clarity in assessments:
  • 4 quadrants approach.
  • Tail of Spence: upper outer quadrant extending into axilla.
  • Clock face system for locating abnormalities.

Breast Structures

• Key anatomical components:
  • Nipple: central part, contains openings for lactiferous glands.
  • Areola: pigmented area surrounding the nipple, contains Montgomery glands.
  • Lymph nodes: important in immune response.
  • Glandular tissue: milk-producing acini cells.
  • Fibrous tissue: provides structural support.
  • Blood vessels: arteries and veins supply blood to breast tissues.

Lifespan Considerations

1. Pregnancy: Hormonal changes lead to breast enlargement.
2. Colostrum: first milk post-delivery, crucial for newborns.
3. Infants and Children: Observe for developmental changes.
4. Tanner Staging: system for staging breast development during puberty.
5. Menarche: onset of menstruation, indicating reproductive maturity.
6. Older Adults: changes in tissue composition and hormonal influence.
7. Breasts in Males: gynecomastia can occur due to hormonal imbalances.

Tanner Staging

• Stages of breast development:
  • 1: Prepubertal.
  • 2: Breast bud develops.
  • 3: Breast elevation.
  • 4: Areolar mound formation.
  • 5: Adult contour.

Assessment Preparation

• Inform the client about procedures.
• Provide privacy and comfort.
• Timing: consider the menstrual cycle for optimal assessment.

Subjective Data Collection

• Inquire about history of:
  • Lumps, pain, and nipple discharge.
  • Changes in breast size or skin appearance.
  • Family history of breast cancer.
  • Menstrual and reproductive history.
  • Use of hormonal medications.

Objective Assessment - Inspection

• Assess for:
  • Symmetry, size, and shape.
  • Skin changes: redness, dimpling, bulging, lesions.
  • Nipple characteristics: retraction, inversion, discharge.

Objective Assessment - Palpation

• Technique: Use pads of three fingers in a circular motion.
• Assess breast tissue from the clavicle to the inframammary line, and midaxillary to midsternal line.
• Examination of the axillae: Support the arm and palpate lymph nodes (central, lateral, pectoral, subscapular).

Normal vs. Abnormal Findings

• Normal: Smooth, firm, elastic tissue; no discharge or masses.
• Abnormal: Presence of lumps, tenderness, peau d’orange, nipple changes, palpable lymph nodes.

Inflammatory Conditions

• Important to differentiate from breast cancer; perform focused assessments to establish accurate care plans.

Priority Urgent Assessment

• Identify common causes such as:
  • Trauma, infection, pain, masses, nipple discharge.
• Signs requiring further investigation:
  • New breast lump, skin irritation/dimpling, nipple changes, discharge.

Patient Education

• Encourage regular self-breast exams (SBE) and awareness of changes.
• Ideal timing: 5-7 days after menstrual period.
• Promote regular clinical breast exams and mammography.

Self-Examination Techniques

• Examine while in front of a mirror, check the armpit, and use different hand patterns (up and down, circular).

Mammogram Process

1. Complete pre-test questionnaire.
2. Compression of breasts between plates for imaging.
3. Horizontal and diagonal compression for thorough imaging.

Documentation and Communication

• Document findings:
  • Location, size, shape, consistency, mobility, tenderness, skin changes.
• Use clock-face method for precise location documentation.
  • Communicate abnormal findings promptly to the healthcare team.

Professional Development

• Practice skills in labs/simulations.
• Review techniques with instructors.
• Advocate for patient education and preventive care.