health assessment

• Breast structure

  • Centrally located nipple of pigmented erectile tissue
  • Sebaceous glands also called Montgomery's tubercles
  • The breasts also called mammary glands
  • A small triangle of tissue called the tail of Spence
  • Musculature fibrous bands called Cooper's ligaments
• Lymph nodes

  • Pectoral lymph nodes - Drain lymph fluid
  • Brachial nodes - Drain most of the arm
  • Subscapular nodes - Drain the posterior chest wall
  • Midaxillary nodes - Located near the ribs
  • Central draining nodes - For the pectoral
  • Internal mammary nodes - Drain the mammary lobes
  • Superficial lymphatic vessels - Drain the skin
• Breast development

  • 12-25 glandular lobes containing alveoli that produce milk surround each breast
  • Breast development by the age of 8-13
• Breast palpation methods

  • Circular
  • Wedged
  • Vertical strip - Most effective method
• Abnormal findings of breast

  • Breast cancer mass - Irregularly shaped mass
  • Ductal carcinoma in situ - The earliest stage developing
  • Infiltrating ductal carcinoma - Spread to the breast
  • Dimpling - Abnormal attachment of the skin
  • Peau d'orange - Thickening and pitting of breast skin
  • Fibrocystic changes - (Benign cyst)
  • Fibroadenoma - Mobile mass that feels slippery
  • Nipple retraction - Displacement of the nipple
  • Paget's disease - Rare for of breast cancer
  • Mastitis and breast engorgement - Disorders that affect lactating females
  • Nipple discharge - Can be elicited by nipple stimulation
  • Breast pain - Commonly results from benign
  • Gynecomastia - (Abnormal breast male)
• Subdivision of airways

  • Upper airways
  • Lower airways
• The larynx


  • Houses the vocal cords
• Thorax


  Identifies the portion of the body
• Lower respiratory system


  • Located in the thorax and constitute
• Thoracic cage


  • 12 pairs of ribs (main structure)
  • Provide support and protection of the organ
• Parts of the sternum and clavicles

  • The manubrium
  • The body
  • Xiphoid process
• Vertical reference lines on the anterior chest

  • Midsternal line
  • Right and midclavicular lines
• Vertical reference lines on the posterior thorax

  • Vertebral line
  • Right and left scapular lines
• Thorax is divided into 3 parallel lines

  • Midaxillary line
  • Anterior axillary line
  • Posterior axillary line
• Mediastinum


  • Refers to a central area
• Lungs


  • Two cone shape
• Pleural membranes


  • Double-layered serous membrane
• Parietal pleura


  Line the chest cavity
• Visceral pleura


  Cover the external
• Pleural space


  Two pleural layers
• Trachea and bronchi


  • Represent "dead space"
• Trachea


  • A flexible structure
• Right main bronchus


  Shorter and more vertical
• Left main bronchus


  Making aspirated objects
• Bronchioles


  • Smaller passageways
• Respiratory muscles


  • Primary muscles used in breathing
• Inspiration


  Process of inflow of air into the lungs
• Expiration


  Mostly passive in nature
• Hypercapnia


  Increased in carbon dioxide
• Hypoxemia


  Increases respiration
• Health assessment


  • Observing the patient's general appearance
• Respiratory rate


  • Adults - 12-20 bpm
  • Infant - 40 bpm
• Accessory muscle use


  • Observe the diaphragm
• Inspecting related structures


  • Inspect the skin, tongue, mouth, finger and nails
• Palpating the chest


  • Should feel smooth, warm, and dry
• Percussion sounds

  • Flat
  • Dull
  • Resonant
  • Hyperresonant
  • Tympanic
• Bronchophony


  Says "99"
• Egophony


  Say "E"
• Whispered pectoriloquy


  Whisper "123"
• Locations of normal breath sounds

  • Bronchial
  • Bronchovesicular
  • Vesicular