STUDY - Technical - New Dacian's Medicine
breast
ulcer (Classical / Allopathic Medicine)
Appearing on the
nipple or areola or on the breast itself, an ulcer indicates
destruction of the skin and subcutaneous tissue. A breast
ulcer is usually a late sign of cancer, appearing well after
the confirming diagnosis. However, it may be the presenting
sign of breast cancer in men, who are more apt to dismiss
earlier breast changes. Breast ulcers can also result from
trauma, infection, or radiation.
HISTORY:
Ask the patient when she first noticed the ulcer and if it was preceded by other breast changes, such as nodules, edema, and nipple discharge, deviation, or retraction.
Ask the patient if anything has made the ulcer better or worse. Does it cause pain or produce drainage?
Ask the patient if she has noticed a change in breast shape. Has she had a skin rash?
Review the patient's medical history for factors that increase the risk of breast cancer. Also, ask the patient for a family history.
If the patient recently gave birth, ask her if she breast-feeds her infant or has recently weaned him.
Ask the patient if she's taking an oral antibiotic or if she's diabetic.
Ask the patient when she first noticed the ulcer and if it was preceded by other breast changes, such as nodules, edema, and nipple discharge, deviation, or retraction.
Ask the patient if anything has made the ulcer better or worse. Does it cause pain or produce drainage?
Ask the patient if she has noticed a change in breast shape. Has she had a skin rash?
Review the patient's medical history for factors that increase the risk of breast cancer. Also, ask the patient for a family history.
If the patient recently gave birth, ask her if she breast-feeds her infant or has recently weaned him.
Ask the patient if she's taking an oral antibiotic or if she's diabetic.
PHYSICAL
ASSESSMENT:
Inspect the breast, noting asymmetry or flattening. Look for a rash, scaling, cracking, or red excoriation on the nipple, areola, or inframammary fold.
Check for skin changes, such as warmth, erythema, or peau d'orange.
Palpate the breast for masses, noting any induration beneath the ulcer.
Palpate for tenderness or nodules around the areola and the axillary lymph nodes.
Inspect the breast, noting asymmetry or flattening. Look for a rash, scaling, cracking, or red excoriation on the nipple, areola, or inframammary fold.
Check for skin changes, such as warmth, erythema, or peau d'orange.
Palpate the breast for masses, noting any induration beneath the ulcer.
Palpate for tenderness or nodules around the areola and the axillary lymph nodes.
SPECIAL
CONSIDERATIONS:
After radiation treatment, the breasts appear sunburned. Subsequently, the skin ulcerates and the surrounding area becomes red and tender.
After radiation treatment, the breasts appear sunburned. Subsequently, the skin ulcerates and the surrounding area becomes red and tender.
AGING ISSUES:
Because the risk of breast cancer is increased in this population, breast ulcers should be considered cancerous until proved otherwise.
Ulcers can result from normal skin changes in elderly patients, such as thinning, decreased vascularity, and loss of elasticity as well as from poor skin hygiene.
Pressure ulcers may result from tight brassieres; traumatic ulcers may result from falls or abuse.
Because the risk of breast cancer is increased in this population, breast ulcers should be considered cancerous until proved otherwise.
Ulcers can result from normal skin changes in elderly patients, such as thinning, decreased vascularity, and loss of elasticity as well as from poor skin hygiene.
Pressure ulcers may result from tight brassieres; traumatic ulcers may result from falls or abuse.
PATIENT
COUNSELING:
Because breast ulcers are easily infected, teach the patient how to apply topical antifungal ointment or cream. Instruct her to keep the ulcer dry to reduce chafing and to wear loose-fitting undergarments. If breast cancer is suspected, provide emotional support and encourage the patient to express her feelings.
Because breast ulcers are easily infected, teach the patient how to apply topical antifungal ointment or cream. Instruct her to keep the ulcer dry to reduce chafing and to wear loose-fitting undergarments. If breast cancer is suspected, provide emotional support and encourage the patient to express her feelings.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)