NR 304 Exam 2

NR 304 Exam 2

Student Name

Chamberlain University

NR-304: Health Assessment II

Prof. Name:

Date

Developmental Breast Changes During Puberty

Puberty is marked by distinct physiological changes, especially in breast development among females. Typically, thelarche, or the onset of breast development, begins between ages 8 and 10 (Jarvis, 2020). A girl experiencing concern about not developing breasts while peers have may prompt reassurance rooted in developmental norms. For instance, it is essential for healthcare providers to avoid dismissive responses and instead offer factual information—highlighting that breast development varies widely and usually precedes menarche by about two years. According to Tanner’s staging, it can take one to six years to progress from stage 2 to stage 5 of breast development (Tanner, 1962).

Clinical Scenarios in Pediatric and Adolescent Breast Assessment

When a young girl presents with breast budding before age 8 (in Black girls) or 10 (in White girls), clinicians should assess body mass index (BMI) due to the correlation between early breast development and obesity (Kaplowitz, 2008). Evaluating BMI helps in identifying potential early menarche or precocious puberty. Similarly, in adolescent girls concerned about delayed menarche, the nurse should inquire about the age at breast development since menarche often follows within two years of breast budding.

Breast Changes During Pregnancy

During pregnancy, breasts undergo several visible and physiological changes. The areolae darken and enlarge, and Montgomery’s tubercles become more pronounced. Visible venous patterns are normal and reflect increased blood supply. Around the fourth month of pregnancy, colostrum may be expressed. This early milk, rich in antibodies, precedes mature breast milk and provides vital immunity for the newborn (Riordan & Wambach, 2010).

Furthermore, breastfeeding is recommended exclusively for the first six months, offering optimal nutrition and immune support for the infant. Education around breastfeeding should address common misconceptions and emphasize its benefits, including bonding and reduction of infant infections (WHO, 2020).

Breast Changes in Aging Women

Aging significantly impacts breast tissue. Postmenopausal hormonal changes cause glandular tissue to atrophy, replaced by connective and fatty tissue, resulting in sagging and flattening of the breasts. These changes are normal and not linked to exercise habits or protein intake (Jarvis, 2020).

When older women express concern about breast shape and elasticity, nurses should explain that such transformations are physiologic and often unavoidable due to declining estrogen levels after menopause.

Breast Cancer Statistics and Cultural Disparities

Breast cancer survival and incidence rates differ across ethnic groups. Black women in the U.S. are more often diagnosed at later stages and with aggressive subtypes such as triple-negative breast cancer. Consequently, the 5-year survival rate is lower for Black women (83%) compared to White women (92%) (American Cancer Society, 2022).

Asian/Pacific Islander women show the highest survival rates across all cancer stages. Additionally, Ashkenazi Jewish women exhibit a significantly higher prevalence of BRCA1 and BRCA2 gene mutations, placing them at elevated genetic risk.

Breast Self-Examinations (BSE)

Although formal monthly BSEs are no longer emphasized, women are encouraged to become familiar with the normal appearance and feel of their breasts. Intermittent self-checks can identify changes that arise between mammograms. Most breast tumors are found in the upper outer quadrant, especially near the axillary tail of Spence (Jarvis, 2020).

During clinical assessments, nurses should inspect for asymmetry, nipple deviation, skin retraction, and peau d’orange appearance, which may signify underlying malignancies. Positioning the patient with the arm raised during palpation helps in revealing any concealed masses.

Supernumerary Nipples and Other Variants

A supernumerary nipple—often mistaken for a mole—may appear along the embryonic milk line. While typically benign and not involving glandular tissue, such findings should be documented but do not necessitate intervention unless associated with other abnormalities.

Lymph Node Response to Breast Pathologies

Most breast lymphatic drainage (>75%) occurs through the ipsilateral axillary nodes. Therefore, recent breast infections often result in enlargement of these same-side nodes. Enlargement of distant nodes (e.g., inguinal or cervical) typically suggests alternative diagnoses.

Male Breast Abnormalities and Cancer

Although rare, male breast cancer accounts for less than 1% of all cases. However, gynecomastia in aging men, often due to hormonal imbalances, should prompt further evaluation to exclude underlying pathology. Unilateral breast lumps in men warrant immediate investigation (American Cancer Society, 2022).

Differentiating Benign from Malignant Breast Conditions

Benign breast disease, characterized by nodularity and tenderness, complicates physical exams by masking new masses. It generally appears in women aged 30-55. While not pre-cancerous, the dense tissue requires careful monitoring for any suspicious changes (Riordan & Wambach, 2010).

Risk factors such as age (over 65), family history of breast cancer, nulliparity, and a history of ovarian cancer elevate a woman’s risk and necessitate more rigorous screening protocols.

Conclusion

Understanding breast development, pregnancy-related changes, aging effects, and pathological signs ensures effective patient education and accurate clinical assessments. Nurses play a crucial role in recognizing normal variations, educating about self-examinations, and identifying signs warranting further evaluation. Tailoring care to cultural and age-specific risks enhances early detection and improves outcomes.

Male Breast Cancer and Lymphatic Spread

Breast cancer in men, although rare, accounts for less than 1% of all breast cancer cases (American Cancer Society, 2024). The limited amount of breast tissue in males allows tumors to more easily spread to nearby axillary lymph nodes. Male breast cancer often goes undiagnosed until later stages due to lack of routine screening and awareness. Compared to women, men are typically diagnosed around 10 years later, and the early signs may be misinterpreted or overlooked.

Characteristics of Cancerous Breast Masses

When a breast mass is identified, such as in a 68-year-old woman with a lump in the upper outer quadrant of the left breast, several key features suggest malignancy:

Cancerous masses are often solitary, unilateral, and painless, with irregular and poorly defined borders (Mayo Clinic, 2023).

Gynecomastia in Males: Related Health Conditions

Bilateral gynecomastia in men may be a symptom of various underlying health issues. Common associated conditions include:

Gynecomastia can also be linked to Cushing syndrome and adrenal disorders (NIH, 2022).

Terms for Range-of-Motion Movements

Movement terminology is crucial during musculoskeletal assessments:

Examples:

• Bringing the hand to the mouth involves flexion.
• Jump rope motion involves circumduction of the shoulder.

Functional Units of the Musculoskeletal System

Joints serve as the functional units because they allow mobility necessary for daily activities. Bones form the structural framework, muscles generate movement, and tendons connect muscles to bones.

Hematopoiesis and Bone Marrow

Hematopoiesis, or the production of red blood cells, occurs in the bone marrow. Other organs like the liver, spleen, and kidneys serve different metabolic or regulatory functions but do not produce blood cells (Johns Hopkins Medicine, 2023).

Structure of the Ankle Joint

The ankle joint, or tibiotalar joint, consists of the articulation between the tibia, fibula, and the talus. Other bones such as the calcaneus and cuboid are part of the foot, not the ankle joint.

Ligaments and Joint Stabilization

Ligaments are fibrous tissues that connect bones and stabilize joints by limiting undesirable movements. Tendons link muscles to bones, while cartilage cushions joints and absorbs shock.

Movements of the Knee

The knee, a hinge joint, allows flexion and extension of the lower leg. It does not permit circumduction, inversion, or pronation.

Spinal Postural Changes and Abnormalities

During pregnancy, women often experience lordosis, a curvature that compensates for the shifting center of gravity. Other spinal abnormalities include:

Functional scoliosis disappears with bending, while structural scoliosis remains.

Vertebrae and Anatomical Landmarks

The spinal column comprises 33 vertebrae:

An imaginary line across the iliac crests intersects the fourth lumbar vertebra.

Intervertebral Disks and Shock Absorption

Intervertebral disks, with their central nucleus pulposus, act as shock absorbers that cushion vertebrae and support spinal movement.

Shoulder Anatomy and Rotator Cuff Injury

The glenohumeral joint is surrounded by the rotator cuff—a group of four muscles and tendons that stabilize the shoulder. Pain during abduction but not forward flexion often indicates rotator cuff injury.

Joint Identification and Palpation Techniques

Osteoporosis Prevention and Patient Education

For perimenopausal women, engaging in physical activity such as brisk walking is the most effective method for delaying or preventing osteoporosis. Medication and supplementation play supportive roles but cannot replace the benefits of weight-bearing exercise.

Musculoskeletal Testing Techniques

Musculoskeletal exams should be conducted in a head-to-toe, proximal-to-distal manner.

Recognizing Arthritic Conditions

Specific Abnormalities and Terminology

Vertigo vs. Syncope vs. Dizziness

Vertigo should be noted when a patient describes the sensation of the room spinning around them.

Neurological Symptoms and Conditions

Seizure Activity and Related Neurological Manifestations

Seizure activity typically presents with sudden alterations in consciousness, involuntary muscular movements, and potential sensory disruptions. In contrast, true vertigo involves a rotational spinning sensation, often resulting from dysfunction within the vestibular system, either in the inner ear or brainstem nuclei. Syncope is defined as a brief loss of consciousness due to reduced cerebral perfusion, whereas dizziness usually implies a less intense, light-headed feeling.

When elderly patients, such as a 70-year-old woman, report dizziness upon standing, it is important for the nurse to recognize this symptom as potentially related to orthostatic hypotension—a condition associated with aging due to decreased cerebral blood flow. Rather than suspect fatigue or dehydration, a nurse should instruct the patient to rise slowly from seated or lying positions. This approach can prevent falls due to the sudden positional drop in blood pressure. Referring for a complete neurological exam would be premature unless symptoms are severe or persistent (Jarvis, 2020).

Assessment of Aura in Seizure Disorders

In individuals with seizure disorders, identifying an aura is a critical component of the health history. An aura serves as a warning sign and may be auditory, visual, or motor in nature. Nurses should ask questions such as, “Do you have any warning signs before your seizure starts?” This question is more effective in identifying an aura than questions concerning muscle tone, postictal states, or autonomic responses (Bickley, 2020).

Cranial Nerve Evaluation

Pupil Changes and Intracranial Pressure

A significant neurological change, such as unilateral dilation and non-reactivity of a pupil, suggests increased intracranial pressure affecting cranial nerve III. This finding is especially critical in patients with head trauma, as it may indicate brain herniation. CN III (oculomotor nerve) lies adjacent to the brainstem and is vulnerable to pressure, making timely evaluation imperative.

Motor Skill Testing in Pediatrics

For children aged 6 years, testing gross motor coordination can be achieved by instructing them to hop on one foot. Normal motor development benchmarks include hopping and single-leg balance. Delays in achieving these milestones may suggest incoordination or neuromotor dysfunction. Activities such as touching one’s nose assess fine motor skills, and making faces evaluates CN VII (facial nerve) function.

Cerebellar Dysfunction and Coordination Tests

In adults presenting with uncoordinated movements, such as missing when attempting rapid alternating motions, cerebellar dysfunction should be suspected. The cerebellum governs equilibrium, voluntary coordination, and muscle tone. Conditions like cerebellar disease manifest as clumsy, delayed responses during motor tests (Jarvis, 2020).

Specific Cranial Nerve Functions

The spinal accessory nerve (CN XI) is assessed by evaluating the patient’s ability to shrug shoulders and turn the head against resistance. This test checks the integrity of the sternomastoid and trapezius muscles. Findings of asymmetrical movement or weakness suggest CN XI impairment. Other tests, such as tongue protrusion (CN XII) or hearing (CN VIII), target different cranial nerves and serve distinct purposes.

Facial asymmetry, sagging eyelids, and air escape when cheeks are pressed point toward motor dysfunction of CN VII. This nerve controls the muscles of facial expression, distinguishing it from sensory or ocular movement cranial nerves (Jarvis, 2020).

Neuromotor Disorders and Diagnostic Clues

Parkinsonism vs Other Neuromotor Conditions

Symptoms such as stooped posture, a shuffling gait, mask-like facial expressions, and pill-rolling tremors are characteristic of Parkinsonism. This condition is neurodegenerative and results in motor disturbances due to dopamine deficiency. Differentiating it from cerebral palsy, cerebellar ataxia, or muscular dystrophy involves close observation of gait, posture, and movement patterns.

Finger-to-Nose Test

The finger-to-nose or finger-to-finger test evaluates cerebellar function. Overshooting or clumsy movement indicates cerebellar pathology or acute alcohol intoxication. The test checks fine motor coordination and accuracy, which should otherwise be smooth and precise in healthy individuals.

Anatomy and Physiology of the Male Reproductive System

Internal and External Structures

The male reproductive system includes external structures such as the penis and scrotum, and internal structures including the testes, epididymis, and vas deferens. The prostate gland, a key accessory gland, produces a milky alkaline fluid that supports sperm viability.

Functional and Structural Considerations

The glans penis is formed from the corpus spongiosum and appears as a cone-shaped erectile tissue. The urethral meatus is typically at the tip of the glans, not on the ventral side. The prepuce or foreskin covers the glans, not the shaft.

Testicular function includes sperm production, which occurs within the testes. The left testis usually hangs lower than the right due to a longer spermatic cord. The cremaster muscle responds to temperature changes by contracting or relaxing to regulate testicular temperature for optimal sperm production (Bickley, 2020).

Changes with Aging

Puberty in males typically begins between ages 9 and 10. The initial sign is testicular enlargement, followed by pubic hair development and penile growth. In older males, common findings include a decrease in penis and testicular size, thinning pubic hair, and a more pendulous scrotum.

Genitourinary Conditions in Males and Diagnostic Indicators

Understanding Phimosis and Urethral Stricture

Phimosis is a condition characterized by the inability to retract the foreskin over the glans penis. It may be congenital or acquired due to scarring from recurrent infections or poor hygiene. On the other hand, a urethral stricture is a narrowing of the urethral lumen, often resulting in reduced urinary stream and urinary retention. These conditions are significant during physical assessment and may require further urological evaluation (American Urological Association, 2023).

Hernias in Adolescents and Adults: Clinical Presentation

When assessing a 16-year-old male who presents with a scrotal swelling that increases with intra-abdominal pressure and diminishes upon lying down, the most likely diagnosis is an indirect inguinal hernia. This type of hernia follows the pathway of the inguinal canal and can extend into the scrotum. It typically presents with pain upon straining and a palpable soft mass that reduces when supine.

Acute Scrotal Pain in Adults

In a 55-year-old man presenting with sudden, severe scrotal pain relieved by elevation, along with redness and swelling, the findings strongly suggest epididymitis. The inflammation leads to tenderness and difficulty distinguishing between the epididymis and testis. The scrotal skin may appear thickened and edematous.

Other differential diagnoses include:

Assessment of Inguinal Hernia in Middle-Aged Men

A painless swelling near the pubis in an obese, middle-aged man that reduces when supine typically indicates a direct inguinal hernia. This condition is more prevalent in men over 40 and is associated with muscle weakness due to factors like heavy lifting and obesity.

Priapism: A Urological Emergency

Priapism is defined as a prolonged and painful penile erection unrelated to sexual stimulation. It may result from erectile dysfunction medications and requires immediate medical intervention to prevent tissue damage (Mayo Clinic, 2022).

Lesions on the Penis: Differential Diagnosis

A red, superficial ulcer on the penis with a non-tender base typically indicates a syphilitic chancre. This lesion appears 2 to 4 weeks post-infection and is often the first sign of syphilis. Other possibilities include:

Nonretractable Foreskin and Penile Anomalies

Phimosis is a condition where the foreskin cannot be retracted over the glans due to tightness. It may cause hygiene issues and infections.

Anatomy and Function of the Anal Canal

The anal canal is the distal portion of the gastrointestinal tract, approximately 3.8 cm long in adults. It is directed forward toward the umbilicus and is lined with modified skin lacking sebaceous glands and hair.

Rectal and Anal Abnormalities

During perianal examination, a blue, shiny sac near the anus with pain and bleeding suggests a thrombosed hemorrhoid. Other findings such as hard masses, skin tags, or abscesses may indicate more severe conditions.

Digital Rectal Examination Techniques

During rectal exams, the finger should be inserted gently toward the umbilicus to avoid pain. A firm, irregular mass should prompt immediate referral due to suspicion of carcinoma. In younger patients like adolescents, internal palpation is typically not performed; only perianal inspection is necessary.

Recognizing Symptoms of Prostatitis

A man with fever, chills, rectal discomfort, and urinary urgency likely has prostatitis. This condition often presents with malaise, dysuria, and perineal pain.

Abnormal Stool Findings

Stool color and consistency can indicate underlying pathology. For instance, steatorrhea appears pale and greasy due to high fat content, while gray-tan stool suggests absence of bile pigments.

Early Detection and Screening for Colon Cancer

Screening for colon cancer includes annual fecal occult blood testing after age 50 (or age 45 for high-risk groups), and a colonoscopy every 10 years. A colonoscope is the most appropriate tool to examine the sigmoid colon.

Prostate Cancer Awareness

The PSA blood test is recommended annually for Black men starting at age 45, and for all other men after age 50. Prostate cancer incidence is highest in African American men, often due to genetic predispositions. Abnormal findings on DRE include firmness, asymmetry, and lack of central groove.

Types of Urinary Incontinence

Urinary incontinence types include:

Symptoms of Alzheimer’s Disease

Indicators of Alzheimer’s include getting lost in familiar areas, misplacing items in unusual places, mood swings, and difficulty performing familiar tasks.

Pregnancy Signs During Early Gestation

Cyanosis and softening of the cervix in an 8-week pregnant woman indicate Chadwick and Goodell signs. These changes result from increased vascularity and hormonal changes in early pregnancy.

References

American Urological Association. (2023). Guidelines on the management of urethral stricture and phimosis. Retrieved from https://www.auanet.org

Centers for Disease Control and Prevention. (2023). Sexually transmitted infections treatment guidelines. https://www.cdc.gov/std/treatment-guidelines

Mayo Clinic. (2022). Priapism. https://www.mayoclinic.org/diseases-conditions/priapism

National Cancer Institute. (2023). Prostate and colon cancer screening guidelines. https://www.cancer.gov

World Health Organization. (2023). Alzheimer’s disease: Facts and figures. https://www.who.int/news-room/fact-sheets/detail/dementia

NR 304 Exam 2

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.

American Cancer Society. (2024). Breast cancer in men. https://www.cancer.org

Johns Hopkins Medicine. (2023). Musculoskeletal system overview. https://www.hopkinsmedicine.org

Mayo Clinic. (2023). Breast cancer symptoms and causes. https://www.mayoclinic.org

NR 304 Exam 2

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

American Cancer Society. (2022). Breast cancer facts & figures 2021-2022. https://www.cancer.org/

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

Kaplowitz, P. B. (2008). Link between body fat and the timing of puberty. Pediatrics, 121(Supplement 3), S208-S217.

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

Tanner, J. M. (1962). Growth at adolescence (2nd ed.). Blackwell Scientific Publications.

NR 304 Exam 2

World Health Organization (WHO). (2020). Exclusive breastfeeding for optimal growth, development and health. https://www.who.int/