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UC NURS 8020C - NURS 8020 TEST 1 SG

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BREAST & AXILLA ASSESSMENTSurface Anatomy  Located between 2-6 ribs Sternum to MAL Superior Lateral Corner of Axilla-Tail of SpenceInternal Anatomy Glandular Tissue-15-20 Lobes-Lobules are alveoli produce milk that converge behind nipple for storage Suspensory Ligaments (Coopers)-Fibrous Bands extend vertically-attach to chest wall-Support breast tissue-Ligaments become contracted in CA, causing dimpling & pitting of skin Adipose Tissue-Lobes imbedded in adipose tissue-Layers of subcutaneous & retromammary fat=Bulk of tissue-Proportions depends on age, pregnancy, lactation and nutritional state Lymphatic -Extensive lymphatic drainage -> 75% drains ipsilateral axillary nodes-Central axillary-High in Axilla-Pectoral (Anterior) lateral edge of pectoralis muscle-axillary fold-Subscapular (Posterior) lateral edge of scapula-Posterior fold-Lateral-along humerus/inside upper arm Screening Recommendations-(45-54) annual mammograms (Highest Dx age group)-Screening should continue if expected to live > 10 yrsMale Breast CA-Increased Mortality-Assess for discharge, nodules, changes in skinMale Presentation-Painless firm mass-Infiltrating ductal most common-Sub-Areolar-most common location Risk Factors-68 is average age of dx-FH 1 in 5-Genetic mutation in BRCA 1&2 (BRCA 2 worse odds)-Radiation exposure to chest-Increased ETOH intake-r/t liver fx (increased estrogen level/decrease in androgen levels)-Klinefelter Syndrome - Additional X chromosome(s)-Prostate Tx (treated with estrogen related drugs)-Gynecomastia-Increased adipose tissue-Obesity-Increased estrogen-fat cells convert androgen to estrogen-Hx of testicular conditions-r/t lower levels of androgen-Hot environments-gas fumes-increased metals-Never being married-Fx after 45 (warning sign)Female Breast CA (Estrogen Exposure) Risk Factors-Risk factors present in 55% of cases-FH present in 10% of cases-Age: ¾ of cases=women < 50; ½ cases=>65-Higher education & income double the risk r/t parity-Higher rates in Caucasian women-+ FH 1* relative-Early menarche-Delayed menopause-1st live birth after 35-Hx of a bx with atypical hyperplasia-Increased ETOH consumption-Overweight after menopause-Birth control and Hormone Replacement TherapyAbnormal Findings in Breast CA-Solitary unilateral mass-Solid, hard, dense, fixed to underlying tissue (Not mobile)-Borders are poorly delineated-Grows painlessly-Most common in upper outer quadrant (Tail of Spence)-S/S occur with advancement of disease processBenign Breast Disease (Fibrocystic)-Nodularity-occurs bilaterally-Regular rope-like-firm, mobile & rubbery-Painful/tenderness-Smooth delineationFibroadenoma-Category of benign breast disease-Popcorn like calcification-Round/Oval/Lobulated-Most common in 20-30’s up to 55 y/o-Solitary non-tender mass-Solid, firm rubbery, elastic, freely moving-Grows quickly & constantly (Unlike Fibrocystic)-Dx by biopsyPaget’s Disease-Malignant disease of the areola &/or nipple-usually has a corresponding tumor in breast tissue-often misdiagnosed as dermatitis Presentation-Scaly dermatitis of the nipple-Itchy/tingling/redness/flaking/crusting of area-Flattened nipple-D/C from nipple-usually yellowish/bloodyRESPIRATORY ASSESSMENTRespiratory Anatomy-Right lobe is shorter because of liver-Right lobe has 3 lobes-Left is narrower because of the heart-Left has 3 lobesRespiratory Physiology-Maintain acid/base balance of arterial blood-Supply 02 to the blood-Eliminate C02-Mechanics depend upon: Intact musculature (GB) & Intact Innervation (Paralysis)Inspiration -Active Process-Diaphragm descends & Cavity expands/Negative Pressure builds/Causing a pressure difference between alveoli & atmosphere/Air moves into the lungExpiration-Passive process/Diaphragm rises & chest cavity contracts/intrapleural pressure increases/air is forced out of the lung to decrease pressureResting Phase-Occurs at end of I&E-No pressure differences-No airflow occurs-Negative intrapleural pressure prevents lungs from collapsing (PEEP)External Respiration Components for gas exchange in the lung-Lung Compliance (COPD)-Lung Volume (PNA/Lobectomy)-Adequate Perfusion (CHF, Anemia)-Adequate Diffusion (Barotrauma)Internal Respiration-Occurs at cellular level-peripheral system-02 carried by HGB/diffuses across capillary bed/HGB picks up C02 by diffusion/Blood returns to the lungs/Diffusion occurs again at capillary bed C02/02 exchangedAuscultation-Determine the condition of the pleura & lungs Anterior-Apices at supraclavicular-Side to side to 6th rib Posterior-Apices at C7-side to side-Bases at T10 Laterally-Axilla to 7/8th ribExpected Sounds Tracheal-Over trachea-Loud, high pitched, tubular-I&E same duration Bronchial-Over manubrium -Loud, high pitched-Expiration longer then Inspiration Broncho-Vesicular-Main bronchus area-Transitional from large to smaller airway passages-Moderate pitch-Inspiration = Expiration Vesicular-Comprises lung fields-Soft, low pitched, rustling-Inspiration longer than expirationAdventitious Sounds Discontinuous (Crackles) -Inspiratory -Intermittent, non-musical, air passing through moisture Fine-Fine, soft, high-pitched, very brief 5-10 seconds-Heard at end of inspiration-Seen in early CHF/PNA/Fibrosis/Bronchitis Coarse-Louder, lower in pitch, longer 20-30 seconds-During inspiration at lung base-Seen in pulmonary edema/PNA/Fibrosis Continuous (Wheeze)-Air being forced through narrowed passage High-Pitched (Sibilant)-Musical, squeaking, continuous through I&E-Predominately heard in expiration-Seen in acute asthma/chronic emphysema Low-Pitched (Rhonchi/Sonorous)-Low pitched, musical snoring, continuous through I&E-Predominately heard in expiration-Seen in bronchitis/obstruction from airway tumor Stridor-High pitched, crowing, originates in larynx/trachea-Upper airway obstruction-Seen in croup/acute epiglottitis/foreign body Pleural Friction Rub-Rubbing/Grating during I&E-Louder in expiration-Loudest over lower/lateral anterior space-Caused by inflammation of pleural surfaces-Accompanied by pain Absence of Sound-Effusion-Atelectasis-ConsolidationPalpitation Maneuvers Respiratory Excursion-Thumbs slide apart on chest wall symmetrically with deep inspiration-Asymmetrical expansion seen with PNA-No expansion seen with emphysema Tactile (Vocal) Fremitus-Palpable vibration from chest wall-Patient repeats number “99” Normal-Symmetrical side to side-same vibration/sequence AbnormalIncrease

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