NR 304 Exam 2

NR 304 Exam 2

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Chamberlain University

NR-304: Health Assessment II

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Developmental Breast Changes During Puberty

Puberty represents a period of significant physiological change in females, with breast development being one of the earliest milestones. Thelarche, or the onset of breast budding, typically begins between the ages of 8 and 10 (Jarvis, 2020). When girls express concerns about delayed breast growth compared to their peers, healthcare providers should provide reassurance, explaining that breast development varies widely among individuals. It is essential to offer factual information rather than dismissive reassurance, noting that breast development usually precedes menarche by approximately two years.

According to Tanner’s staging, the progression from stage 2 to stage 5 may take between one and six years (Tanner, 1962). Therefore, variations in the timing of development are generally considered normal.

Clinical Scenarios in Pediatric and Adolescent Breast Assessment

When breast budding occurs before age 8 in Black girls or before age 10 in White girls, clinical evaluation is warranted (Kaplowitz, 2008). Such evaluation should include an assessment of body mass index (BMI), as early breast development is associated with obesity. Identifying these factors is important because early development may indicate a risk for precocious puberty or early menarche.

For adolescent girls who are concerned about delayed menarche, clinicians should ask about the age at which breast development began, since menarche typically follows within two years.

Table 1. Developmental Events in Female Puberty

Breast Changes During Pregnancy

During pregnancy, breasts undergo both physiological and visible changes. The areolae become darker and larger, Montgomery’s tubercles are more prominent, and venous patterns become visible due to increased blood supply. By the fourth month, colostrum—an antibody-rich early milk—may be expressed, providing critical immune protection for the newborn (Riordan & Wambach, 2010).

Exclusive breastfeeding is recommended for the first six months of life. Patient education should address misconceptions, highlight the nutritional and immune benefits of breastfeeding, and emphasize its role in strengthening maternal-infant bonding (WHO, 2020).

Breast Changes in Aging Women

Postmenopausal hormonal changes cause atrophy of glandular tissue, which is replaced with connective and fatty tissue. This results in sagging and flattening of the breasts, a normal physiological change associated with decreased estrogen levels (Jarvis, 2020). Healthcare providers should explain that these changes are unrelated to exercise or protein intake, reassuring older women about the normalcy of these age-related transformations.

Breast Cancer Statistics and Cultural Disparities

The incidence and survival rates of breast cancer vary across ethnic and cultural groups. In the United States, Black women are more likely to be diagnosed with aggressive forms, such as triple-negative breast cancer, and are often diagnosed at later stages. As a result, their 5-year survival rate is 83%, compared to 92% for White women (American Cancer Society, 2022).

Asian/Pacific Islander women demonstrate the highest survival rates across all stages of breast cancer. In addition, Ashkenazi Jewish women are at greater genetic risk due to a higher prevalence of BRCA1 and BRCA2 mutations.

Breast Self-Examinations (BSE)

While monthly breast self-examinations are no longer universally recommended, women should still become familiar with the normal appearance and texture of their breasts. Intermittent self-checks are beneficial to detect any changes between mammograms. Most breast tumors develop in the upper outer quadrant near the axillary tail of Spence (Jarvis, 2020).

Table 2. Clinical Importance of Breast Areas

Supernumerary Nipples and Other Variants

A supernumerary nipple may appear along the embryonic milk line and is generally benign. These findings should be documented but rarely require intervention unless associated with other abnormalities.

Lymph Node Response to Breast Pathologies

Since over 75% of breast lymphatic drainage occurs through ipsilateral axillary nodes, infections often cause enlargement of nearby axillary nodes. Conversely, enlargement of distant lymph nodes may suggest an alternate pathology.

Male Breast Abnormalities and Cancer

Male breast cancer is rare, accounting for less than 1% of cases. Gynecomastia, which is common in aging men due to hormonal imbalance, should be evaluated to rule out underlying disease. Any unilateral breast lump in men requires urgent assessment (American Cancer Society, 2022).

Table 3. Characteristics of Cancerous vs. Benign Breast Masses

Gynecomastia in Males: Related Health Conditions

Bilateral gynecomastia may indicate underlying conditions such as liver disease, hyperthyroidism, alcohol abuse, malnutrition, or use of certain medications (ACE inhibitors, digoxin, estrogen therapy). It may also be related to adrenal disorders or Cushing syndrome (NIH, 2022).

Table 4. Associated Conditions with Gynecomastia

Musculoskeletal System and Range of Motion

The musculoskeletal system provides structure, enables movement, and protects vital organs. Bones serve as a rigid framework, muscles generate movement, and tendons connect muscles to bones. Importantly, hematopoiesis occurs in the bone marrow rather than in the liver or spleen (Johns Hopkins Medicine, 2023).

Joints are functional units of the system that allow mobility, and each type of movement has a specific range of motion. Understanding these movements helps healthcare professionals evaluate mobility and detect musculoskeletal abnormalities.

Table 5. Range-of-Motion Movements

Table 6. Structure of Ankle Joint

Ligaments stabilize joints, tendons connect muscles to bones, and cartilage cushions bones against friction. For example, the knee allows flexion and extension but does not support circumduction, inversion, or pronation.

Spinal Postural Changes and Abnormalities

Pregnancy often results in lordosis due to a shifted center of gravity. Other spinal abnormalities include kyphosis (excessive thoracic curvature), scoliosis (lateral curvature of the spine), and ankylosis (stiffness or immobility of a joint).

Table 7. Vertebrae and Anatomical Landmarks

Intervertebral disks, which contain the nucleus pulposus, act as shock absorbers between vertebrae.

Shoulder Anatomy and Rotator Cuff Injury

The glenohumeral joint of the shoulder is stabilized by the rotator cuff muscles. Pain during abduction but not forward flexion may indicate a rotator cuff injury.

Table 8. Joint Identification and Palpation

Osteoporosis Prevention

For perimenopausal women, brisk walking and weight-bearing exercise are the most effective preventive measures for osteoporosis. Medications and supplements play supportive roles but cannot fully substitute for physical activity.

Table 9. Musculoskeletal Testing Techniques

Neurological Symptoms and Disorders

Recognition of neurological symptoms in elderly patients is vital for accurate assessment. For example, dizziness upon standing may suggest orthostatic hypotension. In seizure disorders, identifying the presence of an aura is crucial since it may provide an early warning sign (Bickley, 2020).

Table 10. Vertigo vs. Syncope vs. Dizziness

Cranial Nerve Evaluation

Cranial nerve testing is essential to detect neurological dysfunction. For example, unilateral pupil dilation may suggest increased intracranial pressure affecting cranial nerve III (oculomotor nerve). Cranial nerve XI is assessed by evaluating shoulder shrug and head rotation, with asymmetry suggesting impairment. Additionally, facial asymmetry or inability to puff cheeks may indicate dysfunction of cranial nerve VII (facial nerve) (Jarvis, 2020).

Neuromotor Disorders

Neuromotor conditions present with distinctive clinical features, which can aid in diagnosis.

Table 11. Neuromotor Conditions and Key Features

Finger-to-nose testing can be used to assess cerebellar function. Overshooting or clumsy movements typically suggest cerebellar pathology.

References

American Cancer Society. (2022). Breast cancer facts & figures. https://www.cancer.org

Bickley, L. S. (2020). Bates’ guide to physical examination and history taking (13th ed.). Wolters Kluwer.

Jarvis, C. (2020). Physical examination and health assessment (8th ed.). Elsevier.

Johns Hopkins Medicine. (2023). Hematopoiesis and bone marrow function. https://www.hopkinsmedicine.org

NR 304 Exam 2

Kaplowitz, P. B. (2008). Evaluation of precocious puberty. Pediatrics, 121(3), e892–e899.

Mayo Clinic. (2023). Breast lumps: Causes and symptoms. https://www.mayoclinic.org

National Institutes of Health. (2022). Gynecomastia: Causes and treatments. https://www.nih.gov

Riordan, J., & Wambach, K. (2010). Breastfeeding and human lactation (4th ed.). Jones & Bartlett Learning.

Tanner, J. M. (1962). Growth at adolescence. Blackwell Scientific Publications.

NR 304 Exam 2

World Health Organization. (2020). Infant and young child feeding. https://www.who.int