Afroz Lakhani,R.N., BScN
FEMALE BREAST:
Clavicle and 2nd rib down to 6th rib
Sternum to midaxillary line
Often divided into four quadrants
Axillary tail of breast tissue
Areola
Nipple
Hormonally sensitive
Ducts, lobes and lobules
Adipose tissue
Concerning symptoms
Breast lump or mass
Breast pain or discomfort
Nipple discharge
Mastitis
An infection of the breast tissue that causes pain, swelling and redness of the breast.
Mostly in breast feeding.
Tenderness, warm, red.
Usually only one breast.
Techniques of examination
Inspection: sitting position, skin, symmetry, contours and retraction in four views
1. Arms at side
2. Arms over head
3. Arms pressed against hips
4. Leaning forward
Skin: color, thickening, prominent pores (ca)
Size n symmetry: some difference ok
Contour: dimpling, flattening, changes due to mass
Nipples: size and shape, direction, rash, ulceration or discharge.
Palpation: spend 3 mins for each breast
Hold the 2nd, 3rd, 4th fingers together.
Keep the fingers slightly flexed.
Use the pads of the fingers on the examining surface.
Move in a circular motion (approximately the size of a coin).
Use varying pressure when palpating. (Light, medium, and heavy).
Palpate the nipple and note any discharge.
Be sure to cover the entire rectangular area of breast tissue (include the axilla).
Systematic patterns
Concentric Circles:
One begins at the outermost top of the breast and circles inward, ending at the nipple; with the fingers moving in small circles with varying pressure.
Vertical strip pattern:
Starting from the outer most edge of a breast, palpate down in a straight line until reaching the other side of the rectangle. Proceed to move hand medially and palpate back up towards the superior edge - the clavicle. Repeat until you reach the medial border - the sternum
Breast Ca symptoms:
A spontaneous clear or bloody discharge from nipple, often associated with a breast lump
Retraction or indentation of nipple
A change in the size or contours of breast
Any flattening or indentation of the skin over breast
Redness or pitting of the skin over breast, like the skin of an orange
BREAST MALE:
It is important to examine.
Inspect and palpate nipple and areola for nodules, swelling, or ulceration
Distinguish between soft fatty enlargement and firm enlargement, called gynecomastia.
AXILLAExamine with patient sitting or lying down
Inspect skin for rash, infection, unusual pigmentation.
Palpate axillary nodes (often less than 1cm) and non tender.
Use proper technique
MALE GENITALIA
Shaft of the penis
Corpus spongiosum (urethra)
Corpora cavernosa
Scrotum contains testes and epididymis
Testes produce spermatozoa and testosterone
Vas deferens
The health history
Sexual function and preference
Libido, arousal, orgasm, ejaculation
Penile discharge or lesions (STD)
Scrotal pain, swelling, or lesions
Patient’s knowledge about testicular self-examination. (instruction is must)
Techniques of examination
INSPECTION OF PENIS:
skin, foreskin, glans, location of urethral meatus and any discharge.
PALPATION:
note for tenderness
INSPECTION OF SCROTUM:
skin for rashes, contour for swelling, lumps, veins.
PALPATION:
both testis for size, tenderness, nodules
Must check for hernia
Inspect and palpate inguinal and femoral areas for bulges.
FEMALE GENITALIA
The health history
Menarche, menstruation, menopause
Pregnancy
Vulvovaginal symptoms (amount, consistency, color, odor) ck for sores,
lumps, itching?
Sexual activity
Chancre and venereal wart
Chancre
Venereal wart
References:
Lynn S. Bickley: Guide to physical examination, 8th ed. Bates, Lippincott. 2003
http://en.wikipedia.org/wiki/Breast_self-examination
http://medicinenet.com
Images from google.images
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