Beruflich Dokumente
Kultur Dokumente
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Competencies
Distinguish common variations and
abnormal changes of the breasts.
Discuss methods of teaching breast
self-examination to patients.
Identify risk factors for breast
cancer.
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Anatomy and
Physiology— Breast
Areola
Montgomery’s tubercles
Lobes
Lobules
Alveoli or acini
Lymphatic drainage
Axillary nodes: central, pectoral,
subscapular, lateral
Internal mammary chain
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Breast Development
Usually begins at 10 to 11
years of age
Stimulated by estrogen release
during puberty
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Health History
Common chief complaints
Breast mass, tenderness, discharge
Assess the following characteristics
Location
Quality
Quantity
Associated manifestations
Aggravating factors
Alleviating factors
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Health History
Past health history
Breast specific vs. Systemic
Medical
Surgical
Medications
Allergies
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Health History
Family history
Breast cancer
Benign breast disease
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Health History
Social history
Alcohol use
Tobacco use
Work environment
Home environment
Economic status
Ethnic background
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Health History
Health maintenance activities
Diet
Exercise
Breast self-exam
Mammogram
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Assessment
Equipment
Towel, drape, centimeter ruler,
teaching aid for breast self-exam
General approach
Inspection
Patient positions
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Assessment
Assess the following areas
Breasts
Areolar areas
Nipples
Axillae
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Assessment
Assess the following characteristics
Color
Vascularity
Thickening/edema
Size and symmetry
Contour
Lesions/masses
Discharge
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Evaluation of Breast
Mass Characteristics
Definition
Mobility
Tenderness
Erythema
Dimpling or retraction
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Normal Findings
No discharge from nipples in
nonpregnant, nonlactating female
Usually, palpable lymph nodes less
than 1 cm in diameter are clinically
insignificant
Palpation should not elicit pain
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Normal Findings
Consistency of breast tissue is
highly variable depending upon
age, time in menstrual cycle, and
proportion of adipose tissue
Breasts are usually nodular or
granular prior to menses
Variation with breast
augmentation— breasts feel fluid
filled or firm throughout
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Risk Factors for Breast
Cancer
Age > 50
Personal history of breast CA
Mother, grandmother, or sister with
breast CA
Menarche at an early age
Menopause at advanced age
Obesity
Alcohol intake > 3 servings per day
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Risk Factors for Breast
Cancer
American or European descent
Urban dweller
Estrogen therapy
Nulliparous
First birth after age 30
Higher education and
socioeconomic status
Atypical hyperplasia
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Diagnostic Techniques
Mammography
X ray
Ultrasonography
Magnetic resonance imaging