HA06 | BREAST AND AXILLA

• Breast and Axillae


  Part of the body being assessed
• Purpose of breast and axillae assessment

  • To identify signs of breast disease and thereby initiate early treatment
• Learning Outcomes


  • Describe the anatomy and physiology of breasts and axillae
  • Determine which questions about the breasts and axillae to use for focused interview
  • Outline the techniques for assessment of the breasts and axillae
  • Create an appropriate documentation to describe the assessment of the breasts and axillae
  • Identify abnormal findings in the physical assessment of the breasts and axillae
• Subjective Data - Focused Interview Questions

  • Questions related to illness or infection
  • Questions related to symptoms or behaviors
  • Questions related to age and pregnancy
  • Questions related to the environment
• Subjective Data


  Use open-ended and closed-ended questions to obtain information. Follow-up questions are aimed at identifying the source of problems, duration of difficulties, measures to alleviate problems, and clues about the patient's knowledge of his own health. Consideration for age, gender, race, culture, environment, health practices, and past and concurrent problems and therapies should be considered when framing questions and using techniques to elicit information.
• Mastalgia


  Breast discomfort or pain, most often related to the menstrual cycle
• Preparing the Client


  1. Let the client sit in an upright position

  2. Explain that it will be necessary to expose both breasts to compare for symmetry during inspection

  3. One breast may be draped while the other breast is palpated

  4. Be sensitive to the fact that many women may feel embarrassed to have their breasts examined
• Key Points in Physical Assessment

  • Explain to the client the steps of the examination and the rationale for them
  • Warm your hands
  • Observe and inspect breast skin, areolas, and nipples for size, shape, rashes, dimpling, swelling, discoloration, retraction, asymmetry and other unusual findings
  • Palpate breasts and axillary lymph nodes. Perform the physical assessment just as carefully on male clients
• Equipment Needed


  • Examination gown and drape
  • Clean non-sterile examination gloves
  • Small pillow or rolled towel
  • Metric ruler
• Peau d' orange / Pigskin-like


  "Orange peel" appearance caused by edema from blocked lymphatic drainage in advanced cancer
• Breast Self Examination (BSE)

  Once a month right after menses - after 20 years of age, Any given fixed date - menopause women and those who had hysterectomy
• Examination by a physician

  Every 3 years - 20 to 40 years old, Annually - older than 40 years old
• Breast Self Examination (BSE) Steps

  • Bed, Standing, Examination before a mirror
• Nursing Diagnoses


  • Wellness Diagnoses: Readiness for enhanced health management of breast, Health seeking behavior: request information on BSE
  • Risk Diagnoses: Risk for ineffective management of therapeutic regimen
  • Actual Diagnoses: Fear of breast cancer, Ineffective individual coping, Anticipatory grieving, Ineffective management of therapeutic regimen
• The breast is made up of glandular tissue (lobules) and connective tissue (stroma).
• Lactiferous ducts carry milk from lobules to nipples during lactation.
• The axilla is the armpit, which contains lymph nodes that are part of the immune system.
• Lobules are composed of alveoli that produce milk.
• Areolae are pigmented areas around the nipples.
• Areolae are pigmented areas around the nipple that contain sebaceous glands and hair follicles.
• Ducts carry the milk towards the nipple.
• Montgomery's tubercles are small projections found within the areolar region that produce oily secretions.
• Axillary hair follicles can be used as landmarks when performing an examination or palpating the area.
• The skin overlying the breasts has a different texture compared to other areas due to its thickness and fatty layer.
• During pregnancy, hormones stimulate growth and enlargement of breasts.
• Nipples are projections on the surface of the breast that can become erect due to stimulation or cold temperatures.
• Cooper's Ligament supports the lower pole of the breast.
• Breast development begins at puberty with an increase in estrogen levels.
• Suspensory ligaments attach the breast to the chest wall.
• Mammary glands are modified sweat glands responsible for producing milk.
• The pectoralis major muscle lies beneath the breast tissue and helps with arm movement.
• Mammary glands develop at puberty under the influence of estrogen and progesterone hormones.
• Connective tissue provides support and protection to the breast.
• Suspensory ligaments support the weight of the breasts.
• Sebaceous glands produce oil (sebum) to lubricate the skin.
• The nipple is surrounded by pigmented skin called the areola.
• Mammography involves using X-rays to detect breast abnormalities such as lumps, calcifications, and architectural distortions.
• Lobules are clusters of alveoli where milk is produced during lactation.
• Lobules are clusters of alveoli where milk is produced.
• Lobules are clusters of alveoli where milk is produced.