Breast and Genitalia Physical Assessment

• The physical assessment of the breast and genitalia involves techniques and equipment identification.
• The exam includes client and environment preparation, steps and techniques used, and expected findings reporting.
• The techniques used for physical assessment of the breast and genitalia are inspection and palpation.

Breast and Lymphatics

• Breasts are paired mammary glands lying over muscles in the anterior chest wall.
• Breasts lie anterior to the pectoralis major and serratus anterior.
• Breasts extend from the 2nd to 6th rib horizontally and from the sternum to the midaxillary line vertically.
• Breasts are divided into four quadrants intersecting at the nipple, which is important for location of assessment findings.
• The Tail of Spence is in the upper outer quadrant extending to the axillary are, and most breast tumors are located there.
• Lymph nodes are present in male and female breasts.
• Lymph nodes drain lymph from breasts, filter out microorganisms, and return water and protein to blood.

External Anatomy of the Breast

• Skin is smooth and varies in color.
• The Nipple is darker pigment found in the center of the breast and contains lactiferous ducts.
• The Areola surrounds the nipple containing sebaceous glands, hair follicles and smooth muscle fibers that contract the nipple with stimulation.

Internal Anatomy of the Breast

• 3 types of tissue: glandular, fibrous, and fatty.
• Equipment and supplies for the exam includes a centimeter ruler, small pillow, gloves, slides for specimen, and handout for breast self-examination.
• Explain steps of exam with rationale, perform as carefully on male as female.
• Observe and inspect breast skin, areolas, and nipples.
• Palpate breasts and axillary nodes using warm hands.

Female Breast Physical Assessment

• Inspect: Size and symmetry, color and texture, superficial venous pattern, areolas, nipples, and for retraction and dimpling.
• During the exam, the client will be in supine position.
• The breast is palpated from the nipple out to the periphery moving clockwise, and palpates all of breast to the tail of Spence in axilla.
• Use finger pads of the 2nd, 3rd, and 4th fingers with fingers flexes.
• Follow a systematic palpation pattern using small concentric circles or outward spokes-on-a wheel pattern at each point

Palpation Points

• Texture and elasticity
• Tenderness and temperature
• Masses: location, size in centimeters, shape, mobility, consistency, and tenderness
• Milky discharge is normal only during pregnancy and lactation
• Mastectomy or lumpectomy site should be assessed.
• For male breasts, inspect and palpate the breasts, areolas, nipples, and axillae and evaluate for swelling, nodules, ulceration, and gynecomastia.
• Inspect and palpate the axillae for rash or infection.
• Normal assessment: no palpable nodes or one to two small discrete, non-tender, movable nodes in the central area.

Breast Self-Examination (BSE)

• For self examination, lie down and place the right arm behind head.
• Perform while laying down, not standing up, because when lying down the breast tissue spreads evenly over the chest wall as thinly as possible, making it easier to feel.
• Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast.
• Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
• Use three different levels of pressure to feel breast tissue closest to the skin, a little deeper and closest to the chest and ribs.
• Move around the breast in an up-and-down pattern starting at an imaginary line drawn straight down from the underarm.
• Examine each underarm with the arm slightly raised, not too high, to feel in this area.

Preparing Female Clients

• Greet client, introduce self and explain in detail what will be done throughout the examination.
• Elicit client's permission being sure to:
  • Establish an initial nurse-patient relationship
  • Alleviate tension or anxiety
  • Ensure privacy, warmth, ventilation, and adequate lighting
  • Wash hands before commencing the assessment
  • Reassure the client that all data will be kept confidential
  • Provide privacy from unnecessary exposure
  • Respect desires and request of the patient
  • Ask client to urinate before the examination

Preparing the Client for Genitalia Examination

• Ensure clients remove clothing and is wearing a gown with the opening to the back.
• Drape client so that only the genitalia is exposed.
• Ask client to remove underwear.
• If specimen is desired have the specimen container on hand.
• Position the female client appropriately in lithotomy position (if confined to bed, supine with knees flexed).
• Ask the female client not to put hands over head to prevent tightening of the abdominal muscles.
• Relax and put arms at the sides, elevate head and shoulder if possible.
• Explain to the male client that he will be asked to stand to perform the examination.
• If the male client does have an erection, reassure the client that it is not unusual.
• Continue the examination in an unhurried and calm manner.

Examination Equipment

• Stool
• Light source
• Speculum
• Water soluble lubricant
• Cotton tipped applicator
• Specimen container - culturette
• Sterile disposable gloves
• Clean disposable gloves
• Gown
• For female genitalia, inspect and palpate the external and internal structures correctly.
• For male genitalia examination, wear disposable gloves for every step.
• Inspect and palpate the penis, scrotum and inguinal area for inflammation, infestations, rashes, lesions and lumps.
• Describe the importance of Testicular self examination and explain how to perform the examination as you are performing it.
• The reading assignment for the exam material is Testicular self-examination.

Learn about the techniques and equipment for breast and genitalia physical assessment. The exam includes client and environment preparation, steps, and expected findings reporting. Inspection and palpation are key techniques.