CULTURAL FOUNDATIONS OF NURSING- EXAM 3 CHEAT SHEET
CHAPTER 18 – NORMAL BREAST EXAM FINDINGS
Skin
• The skin should appear smooth with uniform coloration.
• Assess for any localized redness, swelling, dimpling, or unusual vascular patterns.
• During pregnancy, a fine bluish vein pattern may be visible, along with stretch marks
(striae).
• Edema is not expected under normal conditions.
Size and Symmetry
• Breasts are often slightly unequal in size; typically, the left is somewhat larger.
• Mild asymmetry is considered normal.
Lymphatic Areas
• Inspect the axillary and supraclavicular regions for swelling, color changes, or edema.
• Lymph nodes are generally not palpable.
o Occasionally, a small, soft, non-tender node may be felt in the central axillary
region.
o Mild tenderness may occur with deep palpation high in the axilla.
Nipples
• Nipples should be aligned symmetrically on both breasts.
• Most nipples protrude, though flat or inverted nipples can be normal.
• Long-standing inversion (unilateral or bilateral) that can be pulled outward is typically
benign.
• Observe for scaling, cracks, ulcers, or abnormal discharge.
• Extra (supernumerary) nipples are a normal variation.
Skin Retraction
• Use specific positioning maneuvers to check for any dimpling or retraction.
Axillary Examination
• Perform the exam with the patient seated.
• Inspect the skin for irritation or infection.
• Support the patient’s arm to keep muscles relaxed.
• Palpate deeply in the axilla, moving fingers in multiple directions.
• Moving the arm through different positions helps improve access.
• Normally, lymph nodes are not felt, though a small, soft node may be present.
• Document any enlarged or tender nodes.
Breast Palpation
• In women who have not been pregnant, tissue is typically firm, smooth, and elastic.
• After pregnancy, the tissue may feel softer and less dense.
• Hormonal changes before menstruation can cause temporary fullness.
• A firm ridge in the lower breast (inframammary ridge) may be felt, especially in larger
breasts; this is a normal finding.
Assessment of Benign Breast Conditions
• Also referred to as fibrocystic breast changes.
• May present with multiple symptoms, including:
o Cyclic breast pain and swelling
o Generalized lumpiness (nodularity)
, o Distinct lumps such as cysts or fibroadenomas
o Nipple discharge
o Inflammatory conditions (e.g., mastitis, abscesses)
• Key Characteristics:
o Very common among women.
o Nodules are often:
▪ Found in both breasts
▪ Firm, mobile, well-defined, and rubbery
o These changes are not cancerous but can make detection of malignancy more
difficult.
o Pain is often cyclical and may feel heavy or dull.
o Some individuals experience nodules without discomfort.
o Cysts are fluid-filled and well-defined.
o Any dominant mass or unusual discharge should be evaluated further.
Breast Anatomy And Quadrants
Location and Structure
• Breasts lie over the pectoralis major and serratus anterior muscles.
• Extend vertically from approximately the 2nd to 6th ribs and horizontally from the
sternum to the midaxillary line.
• The axillary tail of Spence extends into the underarm area.
Nipple and Areola
• The nipple is centrally located and typically protrudes.
• Its surface contains openings for milk ducts.
• The areola surrounds the nipple and contains Montgomery glands (sebaceous glands).
Internal Composition
• Glandular tissue: Contains lobes and lobules responsible for milk production.
• Fibrous tissue: Includes Cooper’s ligaments, which provide structural support.
• Adipose tissue: Makes up most of the breast’s volume.
Quadrants
• The breast is divided into four sections using vertical and horizontal lines through the
nipple.
• The upper outer quadrant contains the axillary tail and is the most common site for
breast tumors.
Breast Exam Timing and Cancer Indicators
• Best time for examination: days 4–7 of the menstrual cycle.
• Mammography is recommended annually starting at age 40–44.
• Suspicious masses tend to be irregular, immobile, and poorly defined.
Lymphatic Drainage of the Breast
• The breast has an extensive lymphatic network.
• Over 75% of lymph drains into the same-side (ipsilateral) axillary lymph nodes.
Axillary Node Groups
1. Central nodes: Located deep in the center of the axilla; receive drainage from other
groups.
2. Pectoral (anterior) nodes: Found along the front edge of the pectoralis major muscle.
3. Subscapular (posterior) nodes: Located along the back of the axilla near the scapula.
4. Lateral nodes: Positioned along the upper arm near the humerus.
, • Lymph then drains to infraclavicular and supraclavicular nodes.
Documenting Abnormal Breast Findings
When describing a breast abnormality, include:
• Location: Use clock-face positioning and distance from the nipple (in cm), or diagram
the area.
• Size: Measure in three dimensions (length × width × depth).
• Shape: Describe as round, oval, lobulated, or irregular.
• Consistency: Note whether soft, firm, or hard.
• Mobility: Determine if the mass moves freely or is fixed.
• Number: Indicate if the lump is single or multiple.
• Nipple changes: Note any deviation or retraction.
• Skin condition: Look for redness, dimpling, or retraction.
• Tenderness: Record any pain upon palpation.
• Lymph nodes: Document presence of enlarged regional nodes.
CHAPTER 22 – ABDOMINAL ASSESSMENT IN THE AGING ADULT
Order of Examination
• The correct sequence is: inspection → auscultation → percussion → palpation
• During inspection, observe for:
o Venous patterns
o Visible peristalsis
o Overall abdominal shape
Quadrant Findings
• Right upper quadrant (RUQ) discomfort may be related to the liver, pancreas, or
ascending colon
• Left upper quadrant (LUQ) is associated with the spleen
• Hyperactive bowel sounds are typically high-pitched and may sound rushing or tinkling
Age-Related Abdominal Changes
• Increased subcutaneous fat is often seen in the abdominal area
• Aging affects abdominal appearance:
o Women may develop fat accumulation in the suprapubic region due to decreased
estrogen
o Men may also gain abdominal fat, especially with reduced activity levels
o Fat distribution shifts from the face and limbs toward the abdomen and hips
• Abdominal muscles:
o Become thinner and lose tone over time
o Appear more relaxed
• In thinner individuals:
o Peristaltic waves may be visible
• Superficial blood vessels:
o May appear more prominent, especially in natural light
• Palpation findings:
o Organs may be easier to feel due to reduced muscle tone
• Pain perception:
o Older adults with acute abdominal conditions may report less pain compared to
younger individuals
CHAPTER 18 – NORMAL BREAST EXAM FINDINGS
Skin
• The skin should appear smooth with uniform coloration.
• Assess for any localized redness, swelling, dimpling, or unusual vascular patterns.
• During pregnancy, a fine bluish vein pattern may be visible, along with stretch marks
(striae).
• Edema is not expected under normal conditions.
Size and Symmetry
• Breasts are often slightly unequal in size; typically, the left is somewhat larger.
• Mild asymmetry is considered normal.
Lymphatic Areas
• Inspect the axillary and supraclavicular regions for swelling, color changes, or edema.
• Lymph nodes are generally not palpable.
o Occasionally, a small, soft, non-tender node may be felt in the central axillary
region.
o Mild tenderness may occur with deep palpation high in the axilla.
Nipples
• Nipples should be aligned symmetrically on both breasts.
• Most nipples protrude, though flat or inverted nipples can be normal.
• Long-standing inversion (unilateral or bilateral) that can be pulled outward is typically
benign.
• Observe for scaling, cracks, ulcers, or abnormal discharge.
• Extra (supernumerary) nipples are a normal variation.
Skin Retraction
• Use specific positioning maneuvers to check for any dimpling or retraction.
Axillary Examination
• Perform the exam with the patient seated.
• Inspect the skin for irritation or infection.
• Support the patient’s arm to keep muscles relaxed.
• Palpate deeply in the axilla, moving fingers in multiple directions.
• Moving the arm through different positions helps improve access.
• Normally, lymph nodes are not felt, though a small, soft node may be present.
• Document any enlarged or tender nodes.
Breast Palpation
• In women who have not been pregnant, tissue is typically firm, smooth, and elastic.
• After pregnancy, the tissue may feel softer and less dense.
• Hormonal changes before menstruation can cause temporary fullness.
• A firm ridge in the lower breast (inframammary ridge) may be felt, especially in larger
breasts; this is a normal finding.
Assessment of Benign Breast Conditions
• Also referred to as fibrocystic breast changes.
• May present with multiple symptoms, including:
o Cyclic breast pain and swelling
o Generalized lumpiness (nodularity)
, o Distinct lumps such as cysts or fibroadenomas
o Nipple discharge
o Inflammatory conditions (e.g., mastitis, abscesses)
• Key Characteristics:
o Very common among women.
o Nodules are often:
▪ Found in both breasts
▪ Firm, mobile, well-defined, and rubbery
o These changes are not cancerous but can make detection of malignancy more
difficult.
o Pain is often cyclical and may feel heavy or dull.
o Some individuals experience nodules without discomfort.
o Cysts are fluid-filled and well-defined.
o Any dominant mass or unusual discharge should be evaluated further.
Breast Anatomy And Quadrants
Location and Structure
• Breasts lie over the pectoralis major and serratus anterior muscles.
• Extend vertically from approximately the 2nd to 6th ribs and horizontally from the
sternum to the midaxillary line.
• The axillary tail of Spence extends into the underarm area.
Nipple and Areola
• The nipple is centrally located and typically protrudes.
• Its surface contains openings for milk ducts.
• The areola surrounds the nipple and contains Montgomery glands (sebaceous glands).
Internal Composition
• Glandular tissue: Contains lobes and lobules responsible for milk production.
• Fibrous tissue: Includes Cooper’s ligaments, which provide structural support.
• Adipose tissue: Makes up most of the breast’s volume.
Quadrants
• The breast is divided into four sections using vertical and horizontal lines through the
nipple.
• The upper outer quadrant contains the axillary tail and is the most common site for
breast tumors.
Breast Exam Timing and Cancer Indicators
• Best time for examination: days 4–7 of the menstrual cycle.
• Mammography is recommended annually starting at age 40–44.
• Suspicious masses tend to be irregular, immobile, and poorly defined.
Lymphatic Drainage of the Breast
• The breast has an extensive lymphatic network.
• Over 75% of lymph drains into the same-side (ipsilateral) axillary lymph nodes.
Axillary Node Groups
1. Central nodes: Located deep in the center of the axilla; receive drainage from other
groups.
2. Pectoral (anterior) nodes: Found along the front edge of the pectoralis major muscle.
3. Subscapular (posterior) nodes: Located along the back of the axilla near the scapula.
4. Lateral nodes: Positioned along the upper arm near the humerus.
, • Lymph then drains to infraclavicular and supraclavicular nodes.
Documenting Abnormal Breast Findings
When describing a breast abnormality, include:
• Location: Use clock-face positioning and distance from the nipple (in cm), or diagram
the area.
• Size: Measure in three dimensions (length × width × depth).
• Shape: Describe as round, oval, lobulated, or irregular.
• Consistency: Note whether soft, firm, or hard.
• Mobility: Determine if the mass moves freely or is fixed.
• Number: Indicate if the lump is single or multiple.
• Nipple changes: Note any deviation or retraction.
• Skin condition: Look for redness, dimpling, or retraction.
• Tenderness: Record any pain upon palpation.
• Lymph nodes: Document presence of enlarged regional nodes.
CHAPTER 22 – ABDOMINAL ASSESSMENT IN THE AGING ADULT
Order of Examination
• The correct sequence is: inspection → auscultation → percussion → palpation
• During inspection, observe for:
o Venous patterns
o Visible peristalsis
o Overall abdominal shape
Quadrant Findings
• Right upper quadrant (RUQ) discomfort may be related to the liver, pancreas, or
ascending colon
• Left upper quadrant (LUQ) is associated with the spleen
• Hyperactive bowel sounds are typically high-pitched and may sound rushing or tinkling
Age-Related Abdominal Changes
• Increased subcutaneous fat is often seen in the abdominal area
• Aging affects abdominal appearance:
o Women may develop fat accumulation in the suprapubic region due to decreased
estrogen
o Men may also gain abdominal fat, especially with reduced activity levels
o Fat distribution shifts from the face and limbs toward the abdomen and hips
• Abdominal muscles:
o Become thinner and lose tone over time
o Appear more relaxed
• In thinner individuals:
o Peristaltic waves may be visible
• Superficial blood vessels:
o May appear more prominent, especially in natural light
• Palpation findings:
o Organs may be easier to feel due to reduced muscle tone
• Pain perception:
o Older adults with acute abdominal conditions may report less pain compared to
younger individuals
