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NUR350 > Assessment of Breasts and Genitalia > Flashcards

Assessment of Breasts and Genitalia Flashcards

1
Q

Trauma Informed Care Considerations for B&G assessment

A
  • promote culture of: safety, healing, empowerment
  • ask for consent at each step
  • explain what will be done, how, and why
  • observe body language
  • avoid false reassurance
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2
Q

Inclusive Care

A

Be mindful and thoughtful in ensuring there is no discrimination against individuals who identify as LGBTQI2S

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3
Q

Inclusive Care Considerations

A
  • don’t assume
  • ask
  • review your workplace to promote inclusion
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4
Q

Anatomical Structures of the breast

A 
Pectoralis major muscle
Axillary tail of Spence
Nipple
Areola
Montgomery's glands
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5
Q

Breasts Landmarks

A 
Upper inner quadrant
Upper outer quadrant
Lower inner quadrant
Lower outer quadrant
Axillary tail of spence
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6
Q

Lymphatic Drainage (Breasts)

A

Axillary Nodes:

a. central axillary
b. pectoral (anterior axillary)
c. subscapular (posterior axillary)
d. lateral axillary

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7
Q

Dev Considerations (Breasts and Female Genitlia) - Adolescence

A

Puberty around age 8-10, estrogen hormones

a. Thelarche (breast development)
b. Adrenarche/pubarche (axillary/pubic hiar)
c. Height spurt
d. Menarche (first period)

*tanner staging

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8
Q

Dev Considerations (Breasts) - Pregnancy

A
  • increase in size
  • blue venous patterns
  • nipples and areolae become larger, nipples more erectile
  • striae
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9
Q

Dev Considerations (Breasts) - Aging Adult

A

Post-menopause

  • fat/glandular tissue atrophy
  • breast size and elasticity decrease
  • ovarian secretion of progesterone and estrogen decrease
  • less dense, lumps more palpable
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10
Q

The Male Breast

A

Rudimentary structure consisting of thin disk of tissue, nipple and areola

gynecomastia - increase in breast gland tissue in men, hormonal imbalance, usually transient and unilateral

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11
Q

Subjective Assessment of Breasts and Axilla

A

a. History of present illness
b. Review of System (trauma, discharge, lump, skin changes, pain or swelling)
c. Associated Symptoms
d. Medical History (surgery, routine check up)
e. Personal and social history
f. Family history

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12
Q

Objective Assessment of Breasts

A

a. General (state of health, general appearance, colour, nutritional status)
b. Vital Signs
c. Inspection
d. Palpation

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13
Q

LACE (for breasts assessment)

A
  1. Look
    - symmetry, masses, dimpling, skin colour, edema, venous pattern, lymphatic drainage area
    - nipples: size, shape, direct, lesions, discharge, supernumerary (extra nipple)
  2. Arm positions
    - hands raised above head (check contour)
    - hands on hips (check for retraction)
  3. Check lymph nodes
    - supraclavicular nodes
    - axillary nodes
  4. Examine breast tissue
    - consistency, elasticity of tissues, tenderness, thickening, lumps or masses
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14
Q

Description of Masses (breasts)

A
  • location
  • size
  • shape
  • consistency
  • fixed or movable
  • nipple
  • skin over the lump
  • tenderness
  • lymphadenopathy
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15
Q

Breast Cancers

A
  • likely age: 30-80 yo
  • irregular, star-shaped
  • hard, dense, fixed
  • often painless
  • grows constantly
  • most common in upper outer quadrant
  • late stage: dimpling, nipple retraction, discharge
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16
Q

Invasive ductal carcinoma (IDC)

A

a form of breast cancer that breaks out of ductal walls and into surrounding tissues, can penetrate into blood or lymph vessels and spread to other organs

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17
Q

Paget’s disease

A

Rare cancer involving nipple and areola

- can happen to men or women

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18
Q

Risk factors for Breast Cancer

A

Non-modifiable:

  • female, age 50-69
  • client or family hx
  • menarche < age 11 or menopause > 55 (increased exposure to hormones)
  • BRCA gene mutation

Modifiable:

  • nullip or first child > 30
  • hormonal contraceptive use
  • obesity

Other:

  • physical inactivity
  • smoking
  • high birth weight
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19
Q

Breast Cancer Assessment/Screening

A

Gail Model
Breast Cancer Risk Assessment Tool
Tyrer-Cuzick Model

MOHTLC BRCA 1/2 Genetic Testing (requires eligibility)
Ontario Breast Screening Program (OBSP) (after 50yo, q2y)

20
Q

Breast Cancer Screening Guidelines

A

CTFPHC recommends NOT screening before 40
- younger individuals have denser breasts, imaging difficult to interpret

Remember B-R-E-A-S-T mnemonic
Breast mass
Retraction
Edema (peau d'orange)
Axillary mass
Skin changes/scaly nipple
Tender breast
21
Q

Structures of the Male Genitalia

A

External:
Penis
Glans penis
Scrotum

Internal:
Urethra
Testis
Epididymis
Vas deferens
Prostate
22
Q

Prostate Gland

A

surrounds bladder neck urethra
2cm behind symphysis pubis (cartilaginous joint)

Bulbourethral gland (right below, secrets clear mucus)

23
Q

Subjective Assessment of Male Genitalia

A

a. History of present illness
b. review of system (discharge, itching, lesions, pain, testicular pain or swelling)
c. associated symptoms
d. medical history
e. personal and social history
f. family history

24
Q

Objective Assessment of Male Genitalia

A

a. General (state of health, general appearance, colour, nutritional status)
b. Vital Signs
c. Inspection
d. Palpation

25
Q

Health history of Male Genitalia

A
  • urinary symptoms
  • past genitourinary history (STIs, hernias)
  • penis (pain or discharge)
  • scrotum (pain or swelling)
26
Q

Scrotal Assessment

A
  1. cup one testicle at a time
  2. examine by rolling the testicle between your thumb and fingers using slight pressure
  3. assess spermatic cord and epididymis
  4. assess irregularities between testicles
27
Q

Description of Masses (Male Genitalia)

A
  • size, contour, nodularity
  • tenderness
  • proximal or distal to testis
  • does it reduce when supine
  • transillumination (using light to illuminate for masses)
28
Q

Inspect and Palpate for Hernia

A

Inguinal region

  • palpate external inguinal ring
  • palpate in femoral canal area
29
Q

Palpate Prostate Gland

A

Press into gland ( from anus)

  • size: 2.5-4cm
  • heart shape, palpable groove
  • smooth, rubbery, slightly movable, non-tender
30
Q

Dev Considerations (Male Genitalia) - Infants and Adolescent

A

Infants
- testes descend along inguinal canal to scrotum
(cryptorchidism-testes not descended)
- uncircumcised/circumcised

Adolescent
Puberty around age 11
*tanner staging

31
Q

Dev Considerations (Male Genitalia) - Aging Adult

A
  • no definite end to fertility
  • pubic hair decreases
  • penis size decreases
  • testes decreases in size, less firm
  • slower and less intense sexual response
  • decrease seminal volume
32
Q

Testicular Cancer

A

Risk factors

  • 15-49 yo
  • undescended testicles
  • family hx

Symptoms

  • lump or swelling
  • tenderness
  • heaviness in abdomen or scrotum

Self exam: Timing, Shower, Examine changes

33
Q

Prostate Cancer

A

Risk factors

  • age >65
  • family hx
  • African ancestry
  • diet high in fat

Symptoms

  • urinary symptoms
  • painful ejaculation
34
Q

Subjective Assessment of Female Genitalia

A

a. History of present illness
b. review of system (discharge, skin changes, irritation, bleeding, pain or swelling)
c. associated symptoms
d. medical history
e. personal and social history
f. family history

35
Q

Objective Assessment of Female Genitalia

A

a. General (state of health, general appearance, colour, nutritional status)
b. Vital Signs
c. Inspection
- skin colour, hair distribution
- vaginal opening and perineum: lesions, masses, colour, discharge, scars
d. Palpation
- mass, tenderness, swelling, discharge, pain
- Skene’s glands
- Bartholin’s glands

36
Q

Structures of Female Genitalia

A 
External: 
Labia majora
Labia minora
Clitoris
Mons pubis
Hymen
Urethral meatus
Internal:
Cervix
Uterus
Ovary
Fallopian tube
Vagina
Anterior and Posterior Fornix
37
Q

Health History of Female Genitalia

A
  • menstrual hx
  • obstetric hx
  • menopause
  • urinary symptoms
  • vaginal discharge
  • sexual activity
  • contraceptive use
  • STI
38
Q

Assessment Considerations (Female Genitalia)

A

a. Lithotomy position
b. Maintain respect
c. Communicate

39
Q

Speculum Exam

A
  1. Proper size and lubricate

2. Inspect cervix and its os

40
Q

Bimanual Exam

A
  1. Cervix
  2. Uterus
  3. Adnexa
41
Q

Dev Considerations (Female Genitalia) - Infant

A

Engorgement of external genitalia

42
Q

Dev Considerations (Female Genitalia) - Pregnancy

A

a. Goodell’s sign: softening cervix at 206 weeks
b. Chadwick’s sign: cervix looks cyanotic
c. Hegar’s sign (ischemic of uterus softens at 6-8 weeks)
d. Uterus increases in size and capacity

43
Q

Dev Considerations (Female Genitalia) - Aging Adult

A
  • Mensus (irregular, then ceases)
  • uterus and cervix shrink
  • ovaries atrophy
  • pelvic musculature weakens
  • vagina shortens, narrows, epithelium atrophies
44
Q

Cervical Cancer

A

Risk factors:

  • sexual intercourse at early age
  • multiple sex partners
  • hx of STIs
  • increasing age
  • compromised immunity (HIV)
  • HPV infection
  • smoking
  • low SES
45
Q

Ovarian Cancer

A

Risk Factors:

  • age >50
  • hx of cancer
  • family hx of ovarian or breast cancer (BRCA 1/2)
  • nulliparous
  • smoking
  • asbestos
  • obesity?

NUR350 (27 decks)

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