- Explain to your patient
- Patient’s permission
- Privacy
- Nurse’s presence
- Semi-recumbent position (45°) , supine, sitting
- Expose upper half of the patient, both breasts exposed
- Arms by the sides , pressed firmly at her waist & elevating the arms above the head
Physical Examination of the Breasts
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A systematic approach includes both inspection & palpation
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Position : patient in the seated position
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Exposure: Both breasts should be exposed to allow for full inspection and assessment for any: 1. breast asymmetry, 2. skin changes (e.g., retraction or erythema), or 3. nipple-areolar abnormalities (e.g., scaling of the nipple or nipple inversion)
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Inspection of the Breast
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Palpation of the breast
Examination Of axilla
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Examined (in sitting position), with the pt’s arm resting over the forearm of the examiner
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Lymph nodes are best detected as you push sup. in the axilla, and then moves the finger tips inf. against the chest wall, trapping lymph nodes
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Palpation in the supraclavicular fossae imp.
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Examination of nipple if history of spontaneous nipple discharge,
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the source of the discharge: localized with systematic palpation from the outer breast to the nipple circumferentially around the areola
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color whether bloody,
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Single or more than one duct is involved
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Whether it is Uni. Or bilateral
(a) Look at the breast for asymmetry and for changes in the skin and nipple.
(b) Ask the patient to raise her hands above her head. This exaggerates asymmetry and skin tethering.
(c) Feel the breast with the flat of your fingers.
(d) Test the mobility of every lump in two directions, with the pectoralis muscles relaxed and tense. Tense the muscles by asking the patient to place her hands on her hips and press inwards.
(e) When you palpate the axilla, hold the patient’s arm to relax the muscles that form the axillary folds.
(f) Compare the axillae simultaneously.
- Stand - see both breast, check for symmetry, lesion, lumps, etc…, exclaim where pain is prior to starting which side
- start in normal side