N104: Essentials of Nursing Care - Health Safety

N104: Essentials of Nursing Care – Health Safety Study Guide

patient can help during the exam. • Explain how the results of the exam will be used. • Ask about presence or history of: o Lumps or masses o Family history of breast disease o

Signs or symptoms (pain, nipple discharge, lumps, etc.) o Last self-breast exam o Last breast exam/mammogram by a clinician • Assess the breasts. o Normal: Rounded shape in female, even with chest wall inmale; uniformcolor; skin smooth and intact; moles; stretch marks; no tenderness; nomasses o Deviations from normal: Recent, sudden change in size; swelling or edema; asymmetry; localized discoloration; dimpling or retraction; tenderness; masses or nodules with palpation • Breast exam: Have the patient in a supine position. Instruct the patient to put her hand behind her head on the side being examined. Using the middle three fingers, make a gentle circular motion on the breast. Start at one point of the breast and systematically palpate all areas. If a mass or lump is felt, record the following in the patient record: o Location using the numbers on the clock face and distance from thenipple (e.g., "at 3 o'clock position 3 cm fromnipple") o Length and width in centimeters o Discrete edges felt or not o Shape: Round, oval, indistinct, regular, and irregular o Consistency: Hard or soft o Mobility: Fixed or moveable o Skin over lump: Dimpled, retracted, or discolored o Tenderness • Assess the areola and nipples. o Normal: Round or oval areola; round nipples equal in size; variable color; sebaceous glands visible on areola; nipples point in same direction; nodischarge from nipples; no tenderness on gentle palpation o Deviations from normal: Asymmetry of areola or nipples; mass or lesion on areola; discharge or cracking of nipples; tenderness on gentle palpation • Assess the axillary and subclavicular lymph nodes: With the patient seatedwith arms abducted and supported, palpate the edge of the pectoral muscle, the thoracic wall in midaxillary area, the posterior axillary line, and the upper part of thehumerus. o Normal: No tenderness, masses, or nodules o Deviations from normal: Tenderness, masses, ornodules Evaluation It is important to compare all findings with previous findings to determine if there are changes to any abnormal breast findings. Record and report any significant deviations from the normal. In many

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