Abdominal Assessment 3 Flashcards
male and female reproductive assessment must be done by
advanced care provider
breast and female genitalia structures
Quadrants, Tail of Spence, Areola, Nipple, Montgomery’s glands, Lymph Nodes
focused breast history
Lump or thickening; Skin changes—red, dimpled, puckered, scaly, or inflamed; Nipple changes—inversion, eversion, discharge; Breast changes—size, shape, contour; Surgery or treatments involving breast; Children, breast feeding; Medications—HRT, BCP; Family—first-line relatives with breast cancer, genetic studies; Psychosocial—Mammogram, BSE; Review of Systems
lumps or masses in breast can be normal if r/t
period, but do monthly self breast examine to make sure they don’t enlarge
Gynecomastia
breast development in males, caused by certain cancers that alter hormones
test braca gene 1 and 2 for
risk of breast cancer, 85 - 95% chance of developing breast cancer
Risk factors of breast cancer - Family history
Premenopausal vs postmenopausal; Early menarch; Prolonged menstrual cycle >50; First child after 30 or never pregnant; Caucasian > Oriental; Genetic mutation in BRACA1 or BRACA2
breast self exam
Timing (when estrogen is lowest); One week after start of menstrual cycle; 3-5 days after period stops; same day each month when breast are less tender: after hysterectomy, oophorectomy, or menopausal; Technique is important—observe patient performing BSE
inspection positions of breast
5 Positions—arms at side, over head, hands on hips, leaning forward, supine with pillow under shoulder
Inspect breast for
Size, shape, symmetry; Skin condition, color variation, venous pattern; Nipple direction, discharge
lumps or masses
Smooth, round, movable, nontender usually normal; Irregular, poorly defined borders, nontender, immovable may be suspicious for malignancy; Warm, hard, painful–mastitis
breast palpation techniques
Vertical strip—up & down across area; Pie wedge—from nipple out; Circle—concentric circles from out to in
breast palpation
Feel for lumps or masses; Small circles with middle three finger pads; Examine breast from midaxillary line to sternal notch; nipple
axillae and lymph nodes palpation
Tail of Spence; Axillary nodes; Clavicular nodes; Epitrochlear nodes - around upper arm
recommendations to look for breast cancer
Self breast exam every month; Clinical breast exam 20-39 years of age; Mammogram every year after 40
inspection and palpation of female
Lithotomy position; External genitalia - Labia, Urethral meatus, Perineum & anus, Glands - Skene’s, Bartholin’s; Internal genitalia - Speculum, Vaginal wall, Cervix, Specimens
Bimanual exam:
Uterus and Adnexal exam (ovaries)
Rectovaginal exam:
occult blood
inspection and palpation of male
Hair distribution; Shaft of Penis—uncircumcised, retract foreskin; Scrotum; Urinary meatus
palpation of male
Use thumbs and index/middle finger; Usually thumb on top with finger underneath testes; Roll testes between fingers and thumb both horizontal and vertical; Check for hernias and lymph nodes at groin
testicular exam
Timing—after warm shower every month; Testicles - shape, size, color (left lower than right), smooth, oval, sensitive to pressure; Epididymis—create bulge on upper back, soft, spongy, not as smooth as testicles; Spermatic cord (vas deferens) - extends into pelvis
Testicular Cancer risk factors
Age 20-40 (in young adults); Undescended testicles (cryptorchidism); Family history; Mumps; DES exposure
Signs & Symptoms of testicular cancer
Hard, fixed, nontender mass; Scrotal swelling, scrotal heaviness
digital rectal exam
Position—stand and bend over exam table; Symptoms—urinary, back pain; Prostate - Benign prostatic hyperplasia/hypertrophy, Cancer; Recommendations - Monthly TSE, DRE (check occult blood) & PSA over age 50
factors affection sexuality
Chronic pain; Diabetes; CV disease; Myocardial Infarction; Joints/Mobility; Surgery—body image; Spinal Cord Injury; Mental Illness; STD; Medications
inspection
contour symmetry, umbilicus, skin, pulsation or movement, demeanor
ausculation
bowel sounds (diaphragm) start RLQ 5-30 min
hyperactive bowel sounds
loud, high pitched, rushing sounds increase motility
hypoactive or absent bowel sounds
occurs throughout surgery w/ inflammation of the peritoneum
vascular sounds
(bell) arota, renal, iliac, and femora
