Question

Breast and regional lymphatics

What educational topics can we cover with the patient? Important educational topics we can discussed with the patient include

How can we encourage a healthy lifestyle? (breast self-exam, mammograms, etc.)

Therapeutic communication?

Answer 1

#. Heath teaching :-

- Mammography

Necessary screenings - BSE, CBE, mammograms

American Cancer Society recommendation

20s or younger teach self-breast examination (SBE)

Age 20 - 39: CBE q 3 yrs.

Age 40 and older: Annual mammogram, CBE

Family history of breast cancer

Detect small, potentially curable cancers

- Clinical Breast Examination

Screens for breast masses/abnormality

Evaluates presenting symptoms

Presents opportunity to teach self awareness and self examination

Inspection: Normal & Abnormal Findings

General appearance - symmetry of size, shape

Left breast - may be larger

Concern -sudden increase in size

Skin - smooth, even color

Concern - redness, bulging, dimpling, lesions, abnormal patterns

Normal - vein network, striae with pregnancy

Concern - increased pigmentation, redness, heat, unilateral/dilated superficial veins, edema, "orange-peel"

Axillary/supraclavicular (lymphatic drainage)

Concern - rash, infection, bulging, discoloration, edema

Nipples - symmetry, retraction, inversion

Screen for retraction, discharge

- Arms at side

Above Head

On Hips

Palms together

Lean forward

To inspect symmetry

- Palpation Techniques

1. Vertical strip pattern of palpation

2. Wedge pattern of palpation; AKA Spokes of a wheel

3. Concentric circles pattern of palpation

4. Palpating the axillae

5. Nipple squeeze to assess for discharge

- Teach Bimanual Palpation

For large pendulous breasts

Seated, leaning forward

Support lower part

Palpate breast tissue against the supporting hand

- Teach Notable Characteristics of a lump/mass

Baseline examination - unaffected breast

Location - clock face

Size - judgement, width x length x thickness

Shape - oval, round, lobulated, indistinct

Consistency - soft, firm, hard

Mobility - Fixed, movable

Distinctness - solitary, multiple

Nipple - displaced, retracted, inverted

Skin - Is it erythematous, dimpled, or retracted?

Tenderness

Lymphadenopathy

#. Promoting Breast Health

Healthy weight

Diet - fruits, vegetables, whole grains,

Avoid red meat, saturated fat

Vitamin D

Minimize alcohol intake

Exercise

Tobacco products, second-hand smoke

Stress management

Sleep

Breast feed infants

Careful decisions - HRT post menopause

Schedule - CBE, mammogram

Perform SBE monthly