PDF: Breast & Genitalia Physical Assessment

Physical Assessment of the BREAST & GENITALIA PRESENTED BY: MRS. KERON JONES-FRASER PHD CANDIDATE, MSCN, BSCN, CERT ED, RN  2 Objectives At the end of this presentation, students should be able to: 1. State the techniq...

Physical Assessment of the BREAST & GENITALIA PRESENTED BY: MRS. KERON JONES-FRASER PHD CANDIDATE, MSCN, BSCN, CERT ED, RN  2 Objectives At the end of this presentation, students should be able to: 1. State the techniques involved in carrying out physical assessment of the genitalia. 2. Identify the equipment needed for the physical assessment of the genitalia.  3 Objectives 3. Outline the preparation of client and environment for the assessment of the genitalia. 4. Outline the steps and appropriate techniques used in the assessment of the genitalia. 5. Report the expected findings from the assessment of the genitalia.  4 Techniques The two techniques used to carry out physical assessment of the breast & genitalia are:  Inspection  Palpation Breast & Lymphatics  Breasts: paired mammary glands lieover muscles, anterior chest wall - anterior to: pectoralis major, serratus anterior Extend: horizontally:2nd to 6th rib; vertically: sternum to midaxillary line Breast & Lymphatics  Location of Assessment Findings Breasts: divided into 4 quadrants intersecting at nipple Tail of Spence: upper outer quadrant; extends to axillary area; location of most frequent occurrences of breast tumors Breast & Lymphatics Lymph Nodes Present in male and female breasts Drain lymph from breasts (filter out microorganisms; return water and protein to blood) Breast & Lymphatics  External anatomy of breast  Internal anatomy of  Skin: smooth; varies in color breast  Nipple: darker pigment;  3 types of center of breast; contains tissue lactiferous ducts  Areola: surrounds nipple; Glandular contains sebaceous glands, Fibrous hair follicles, smooth muscle fibers that contract nipple Fatty with stimulation Breast & Lymphatics Breast & Lymphatics Equipment and supplies Centimeter ruler Small pillow Gloves Slides for specimen Handout: Breast Self-Examination Breast & Lymphatics Key assessment points Explain steps of exam with rationale; perform as carefully on male as female Observe, inspect: breast skin, areolas, and nipples Palpate (warm hands): breasts and axillary nodes Breast & Lymphatics Physical Assessment: Female Breasts – Inspect: Size and symmetry Color and texture Superficial venous pattern Areolas Nipples For retraction and dimpling Breast & Lymphatics Palpate Breasts and axilla: Patient is in supine position, breast is palpated from the nipple out to the periphery, moving clockwise, palpate all of breast to the tail of Spence in axilla Use finger pads of the 2nd, 3rd, and 4th fingers with fingers flexed Be systematic using small concentric circles or outward spokes-on-a wheel pattern at each point Breast & Lymphatics Palpation: Breasts  Texture and elasticity  Tenderness and temperature  Masses: location, size in centimeters, shape, mobility, consistency, tenderness  Milky discharge normal only during pregnancy and lactation  Mastectomy or lumpectomy site Breast & Lymphatics  Physical Assessment: Male  Axilla Breasts  Inspect and palpate  Inspect and palpate the the axillae breasts, areolas, nipples,  No rash or infection and axillae  No palpable nodes or  No swelling, nodules, or one to two small ulceration should be discrete, non-tender, detected movable nodes in the  Gynecomastia central area Breast Self-Examination (BSE) Female genitalia Male genitalia  20 Preparation of client & environment  Greetclient, introduce self and explain in details what will be done throughout the examination  Elicit client’s permission.  Preparation Establish an initial nurse-patient relationship Alleviate tension or anxiety Ensure privacy, warmth, proper ventilation and adequate lighting. Wash hands before commencing the assessment.  Preparation  Reassure the client that all data will be kept confidential  Provide privacy from unnecessary exposure  Respect desires and request of the patient  Askclient to urinate before the examination (to prevent bladder discomfort)  Preparation  Ensureclient removes clothing and is wearing a gown with the opening to the back  Drape client so that only the genitalia  Ask client to remove underwear  If specimen is desired have the specimen container on hand  Preparation  Positionthe female client appropriately in lithotomy position (if confined to bed, supine with knees flexed)  Askthe female client not to put hands over head (to prevent tightening of the abdominal muscles). Instead relax and put arms at the sides, elevate head and shoulder if possible.  Preparation  Explain to the male client that he will be asked to stand (if able) for most of the examination.  Ifthe male client does have an erection, reassure the client that it is not usual and continue the examination in an unhurried and calm manner.  Equipment  Stool  Light source  Speculum  Water soluble lubricant  Cotton tipped applicator  Specimen container - culturette  Sterile disposable gloves  Clean disposable gloves  Gown  Assessment of female genitalia  Inspectand palpate female external and internal structures correctly.  Assessment of male genitalia  Weardisposable gloves for every step of the male genitalia examination.  Inspect and palpate the penis, scrotum and inguinal area for inflammation, infestations, rashes, lesions and lumps.  Describethe importance of Testicular self examination and explain how to perform the examination as you are performing it.  Reading assignment  Testicular self-examination  30 References Bickley, S.B. (2018). Bate’s guide to physical examination and history taking Lippincott Williams & Wilkins. Craven, R., & Hirnle, C. (2007). Fundamentals of nursing: Human, health and function (5th. ed.)Lippincott Williams & Wilkins. Hagen, M. G., & MD Pauly, R. R. (2000). Review of Systems: Essentials of Patient Care. Retrieved from http://medinfo.ufl.edu:8050/ year1/epc- old/review_of_systems_10_27 _06.pdf  31 References Jarvis, C. (2018). Physical assessment and health assessment Saunders, Elsevier. Weber, J., & Kelly, J. (2018). Health assessment in nursing. Lippincott, Williams and Wilkins.