TEACH FOR NURSES LESSON PLAN
Chapter 18: Breasts, Axillae, and Regional Lymphatics
CHAPTER OBJECTIVES
1. Identify significant breast anatomy.
2. Describe the composition of breast glandular tissue.
3. Relate the changes that occur in Cooper’s ligaments with cancer.
4. Describe the ways of documenting clinical findings from a breast examination.
of the breasts.
STUDENT RESOURCES
understand
• Textbook Chapter 18
• Sherpath for Medical-Surgical Nursing*
• Animations (Evolve website)
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apply
• Case Studies (Evolve)
synthesize
• SimChart*
• Simulation Learning System*
INSTRUCTOR RESOURCES
before class
• Nursing Curriculum Standards (below)
in class
• PowerPoint Presentations (Evolve)
after class
• Test Bank (Evolve)
• HESI Practice Tests*
* Sold separately from textbook.
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
INTERNAL ANATOMY
LYMPHATICS
Bring in a model and a
diagram of a breast and
review the external and
• Activity: Obtain a diagram of the breast and have students label the different tissues, ligaments, and
breast characteristics or have them draw a sketch of the breast and surrounding tissues.
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TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
The Aging Woman
of most breast tumors.
Explain the function of
lymphatic drainage using a
Review the development
of the breast, starting with
puberty, and discuss how
hormone development
stimulates breast changes.
Use Table 18.1 to explain
Tanner staging. Discuss the
common changes in
breasts during menarche.
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TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
Breast Cancer
testosterone deficiency in
the aging male.
SUBJECTIVE DATA
Breast
Axilla
Additional History for the
Preadolescent
Emphasize the importance
of being sensitive to a
patient’s anxiety and
attitude about having the
breasts examined. Review
each of the examination
questions and its rationale.
Explain how to do a breast
self-exam.
• Discussion Topic: Discuss how patients can lower their risk of breast cancer.
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TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
factors in Table 18.2.
emphasizing reassurance
for the patient that these
changes are normal.
OBJECTIVE DATA
INSPECT THE BREASTS
General Appearance
Skin
TEACH BREAST SELF-
EXAMINATION
THE MALE BREAST
Show a video
demonstrating how to
prepare a patient for a
breast exam. Explain the
equipment needed for the
exam. With the help of a
volunteer, demonstrate
the positions used for the
axillary and supraclavicular
regions.
Define supernumerary
nipple.
• Activity: Have students interview a Reach to Recovery volunteer (by contacting the local chapter of
the American Cancer Society). Have them share their interview with the class.
• Activity: Assign students to perform a breast exam on a patient in a clinical setting.
• Activity: Designate a day each month to remind female students to do a breast self-examination.
• Discussion Topic: Discuss the importance of examining the male breast and ways of creating an
environment that will provide psychological comfort for both patient and practitioner.
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TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
Review the position of the
patient and palpations of
the axillae in four
directions.
Ask a male volunteer to
act as a patient and
demonstrate the
examination in this
section. Review areas of
palpation. Review care for
adolescent males. Discuss
both normal and possible
abnormal findings.
and body mass index when
examining an adolescent.
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TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
The Lactating Woman
The Aging Woman
Explain that a chart can be
helpful in showing the
adolescent the normal
stages of breast maturity.
IN-CLASS/ONLINE CASE STUDY
D.F. is a 27–year–old woman who presents to the gynecologist’s office for her yearly examination complaining of bilateral breast pain and tenderness.
Subjective Data
Last menstrual cycle: 18 days ago
Pain is dull pain
Breasts feel heavy and tender
Performs monthly breast self-examinations
Objective Data
Breasts moderate size, evenly pigmented, bilaterally symmetric, and hang equally with smooth contour. Venous patterns bilaterally similar.
Questions
1. What other questions should the nurse ask about the breast pain?
2. What are some of the causes of breast pain?
3. Develop a problems list from the objective and subjective data.
4. What should be included in the plan of care?
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5. Based on the readings and the subjective and objective data, what is the most likely cause of breast pain for this patient?
Answers
1. Questions or assessments associated with breast pain include the following:
2. Benign breast disease is a term that represents a number of breast-related symptoms and problems, including breast pain or tenderness,
3. The problems list includes the following:
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NURSING CURRICULUM STANDARDS
QSEN/NLN COMPETENCIES
• Patient-Centered Care/Human Flourishing
o The Adolescent
o The Male Breast
o Additional History for the Preadolescent
NURSING CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).
St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis
textbook.
A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.
THEME: Sexuality and Reproduction
BSN ESSENTIALS
• Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice
o Table 18.5: Differentiating Breast Lumps
• Essential III: Scholarship for Evidence-Based Practice
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o Breast Cancer
o Teach Breast Self-Examination
• Essential VIII: Professionalism and Professional Values
o Subjective Data
ANSWERS TO QUESTIONS IN THE STUDY GUIDE
Note: Answers to these questions can be found on Evolve site. Click here.