Breast and Genetalia

Question 1

What is the rationale for breast assessment

Answer 1

1. To detect abnormalities in th e breast.
2. To teach the client how to perform breast examination.

Question 2

What are the 3 patterns used in assessing the breast?

Answer 2

• wedge pattern
• vertical strip pattern
• circular method

Question 3

Imagine that the breast is broken into a series of pie type slices, with the nipple at the center.
• Start at the nipple, working outwards toward the periphery of the slice that you are examining. Move your hands a few centimeters along each time. When you are clearly no longer over the breast, move to the next slice Make sure that you palpate the stail of the Spence”.
Vertical Strip Pattern or Linear

Answer 3

Wedge pattern

Question 4

• * Start at the clavicle, adjacent to the axilla.
• Move fingerpads down in a vertical line until the area below the breast is reached.
• Then move a bit more medially, and examine while moving upward towards the top of the breast.
• When you reach the clavicle, move medially and repeat until the entire breast

Answer 4

Vertical Strip Pattern or Linear Metho

Question 5

Start at the nipple, work along in circular fashion, fingerpads moving in spiral patter towards the periphery. Make sure to palpate the tail of Spence.

Answer 5

Circular method

Question 6

What are the abnormal findings in the breast?

Answer 6

• skin dimpling
• lumps
• changes in color
• changes of the nipple
• bloody discharge

Question 7

What is the best time for doing breast assessment?

Answer 7

1 week after the period starts

Question 8

What is the rationale for Review personal and family history, risk factors that may be associated with development of breast cancer.

Answer 8

To get baseline data information and determine risks factors

Question 9

Have client disrobe down to the waist and have her put on a gown with the opening on the front.

Answer 9

To provide easy access while maintaining privacy this easing client’s anxiety.

Question 10

Inspect the breasts for symmetry, and contour or shape; inspect color and texture. Explain what you are observing.

R: To determine localized ____ or hyperpigmentation, _____ , _____ and ____.

Answer 10

• discoloration
• retraction
• dimpling
• edema

Question 11

Inspect breast, areola, and nipples with:
Client’s arm hanging freely at the sides

R: : To assess the _____.

Answer 11

breasts accurately

Question 12

• client’s arm raised and held up for s few seconds
R:

Answer 12

To contract the pectoral muscles.

Question 13

• client’s hands pressed down on the hips to emphasize any retraction in the breasts.
R:

Answer 13

• To bring out dimpling and retraction.

Question 14

• client leaning forward from the waist. Breasts should hang freely.
R:

Answer 14

• To reveal asymmetry of the breast or nipple not otherwise invisible.

Question 15

Still in sitting position, inspect
and palpate the axilla. Check
axillary skin for ____ or
_____.

Answer 15

• rashes
• infection

Question 16

Hold the client’s elbow with
one hand (use left hand to
examine the right side). Use ____
finger pads to palpate firmly
the axillary lymph nodes.

Answer 16

3

Question 17

Assess the ____:
Supporting the client’s arm, turn the fingerpads towards the humerus and gently palpate the inner aspect of the arm.

Answer 17

Lateral nodes

Question 18

Assess the _____:
Palpate towards the back of the scapula.

Answer 18

posterior node

Question 19

C. Assess the _____:
Palpate to feel the anterior axillary nodes.

Answer 19

anterior or pectoral nodes

Question 20

10. Palpating the breasts.
    a. Place client in ___ position.
    R: To ___ the breasts ____ against the chest wall, facilitating palpation.

Answer 20

• supine
• flatten
• evenly

Question 21

b. Instruct client to place the arm overhead on the same side as the breast is being palpated. Use the flat pads of the 3 fingers in palpating the breasts.
R:

Answer 21

To allow smooth and systematic palpation of the breast.

Question 22

Be sure to palpate every square inch of the breast, from the nipple and areola to the periphery of the breasts tissue. Vary the levels of pressure as you palpate.
Light - _____
Medium - ____
Firm - ____

R:

Answer 22

• superficial
• mid-level tissue
• to thwart ribs

To assure that the breast is examined in its entirety.

Question 23

11. If client wishes, teach the technique of breast self-examination.

R:

Answer 23

To help client understand the normal look and feel of her breasts and to prevent serious findings.

Question 24

Equipments for assessing the female genetalia

Answer 24

• Goose neck lamp
• Sterile gloves
• Drape
• Vaginal Speculum (size depends on vaginal opening)
• Cytological Materials
  ( Ayre spatula, cytobrush, cotton tipped applicator, glass slides, fixative spray, reagents (normal saline sol., potassium hydroxide)
• Sterile warm water
• Water soluble lubricant

Question 25

4. Inquire about the following: age, date of onset of menstruation, last menstrual period (LMP), regularity of cycle, duration, amount of daily flow, and whether menstruation is painful; incidence of pain during intercourse; vaginal discharge; number of pregnancies, number of live births, labor or delivery complications; urgency and frequency of urination at night; blood in urine, painful urination, incontinence; history of sexually transmitted infection, past and present R: ?

Answer 25

To collect baseline information about client's sexual history.

Question 26

How to prepare the px for assessment

Answer 26

1. Ask px to empty bladder or defecate 2. Remove underwear and put gown with opening at the back 3. Keep upper chest and legs draped 4. Position px in dorsal recumbent or lithotomy position with elevated head and shoulders

Question 27

5. Ask if client needs to empty bladder or defecate. R?

Answer 27

To promote comfort and relaxation during examination

Question 28

6. Ask female client to remove underwear and put a gown with an opening at the back R:

Answer 28

To facilitate proper examination of the genitalia.

Question 29

Keep upper chest and legs draped and keep room warm. R?

Answer 29

To avoid exposing and chilling the client

Question 30

8. Position client: Females should lie in dorsal recumbent on lithotomy position w/ relax her arms at her sides. -To relax the_____ , arms rest at the sides Elevate the head and shoulders. •To _____during

Answer 30

- abdominal muscle - maintain eye contact

Question 31

ASSESSING THE GENITALIA 9. Drape client appropriately. Expose perineal area, repositioning the sheet as needed. R?

Answer 31

To avoid exposing the client

Question 32

10. Inspect surface characteristics of perineum. Note _____ and be alert for signs of ______ R: To determine if further evaluation or treatment is needed

Answer 32

- hair distribution - infestation

Question 33

11. Observe the labia majora and perineum for _____ , _______ and ______. Keep in mind the woman's childbearing status during inspection.

Answer 33

- lesion - swelling - excoriation

Question 34

Use your gloved hand to separate the ___, _____, ______ , and _____.

Answer 34

- labia majora - clitoris - urethral meatus - vaginal opening

Question 35

13. Palpate ______. Place ______ in the tenderness and vaginal opening and _____ on the labia majora. With a _______ motion, palpate trom the inferior portion of the posterior labia majora to the anterior portion. To assess for ____, _____, _____

Answer 35

- Bartholin glands - index finger - thumb - gentle pinching swelling, tenderness amd discharge

Question 36

Palpate the ____ , insert gloved index finger into the superior portion of the vagina and ____ the urethra from the inside, pushing up and out. To confirm suspicions of ____ and _____ of _____

Answer 36

- urethra - milk - urethritis - inflammation - skene’s gland

Question 37

Inspect the ____ of the vaginal opening and ____ of the vagina. Insert the gloves index finger into the vagina, noting the size of the opening and whether the lining of the vagina is thinning or feels dry. To establish the size of the ____ needed for the examination.

Answer 37

- size - angle - speculum

Question 38

Inspect the vaginal _____. Keep your index finger inserted in the client's vaginal opening. Ask the client to _____ around your finger. To check for _____.

Answer 38

- musculature - squeeze - vaginal muscle tone

Question 39

17. When assessing the cervix, examiner must be aware of the guidelines for using the speculum. With the speculum inserted in position to visualize the ____, observe cervical ____, ____, and _____. Also observe the surface and the appearance of the os. Look for discharge and lesions.

Answer 39

- cervix - color - size - position

Question 40

Sit on stool with the client ____ you and in ____ position. Ask client to raise his gown or drape. Expose perineal area. Note _______pattern. Observe genitalia for _____, ______, or _____.

Answer 40

- facing - standing - pubic hair growth - rashes - excoriations - lesions

Question 41

2. Inspect and palpate penile surfaces. A. Inspect _____, _____, _____ , and _____. Retract _____ in uncut males. Return foreskin in normal position. - To observe for discharges, lesions, edema and inflammation.

Answer 41

- corona - prepuce - glans urethral meatus - shaft - foreskin

Question 42

3. Inspect and palpate testicular surfaces, A. inspect ___, ____, ____ and ____ of testicles and scrotum. R: To detect swelling, lumps and bulges.

Answer 42

- size - color - shape - symmetry

Question 43

B. _____ squeeze the glans between index finger & thumb for discharges. C. Ask client to hold penis out of the way.

Answer 43

- gently

Question 44

D. Spread out the _____ (rugae)of skin. Lift the scrotal sac to inspect the posterior skin. To observe color, integrity & lesions or rashes.

Answer 44

- scrotal fold

Question 45

E. Ask the client to shift his weight to the ____ for palpation of the right _____ and vice versa. R: To detect bulges in the inguinal and femoral areas.

Answer 45

- left - inguinal canal

Question 46

• Place your right index finger into the client's right scrotum and press upward, invaginating the loose folds of the skin. R: to detect ___ in inguinal and femoral areas

Answer 46

bulges

Question 47

Palpate up the spermatic cord until you reach the triangular-shaped, slit-liked opening of the _______. Try to push your finger through the opening and, if possible, continue palpating up the inguinal canal.

Answer 47

- external inguinal ring

Question 48

• When your finger is in the canal or at the external inguinal ring, ask the client to _____ or _____. Feel for any bulges against your finger. Then, repeat the procedure on the opposite side.

Answer 48

- bear down - cough

Question 49

Female client remains in _____ position or assumes side-lying (Sim's) position. To allow optimum visualization of the rectum.

Answer 49

- dorsal recumbent

Question 50

2. Male clients ____ and ____ forward with hips flexed and upper body resting across examination table; examine non-ambulatory client in Sim's position.

Answer 50

- stands Bends

Question 51

3. View perianal and sacrococcygeal areas by gently retracting buttocks with your nondominant hand. To check for abnormalities. Perianal skin is normally smooth, more pigmented, and coarser than skin covering the buttocks.

Question 52

4. Inspect anal tissue for skin characteristics, _____ , _____, _____, _____ and _____.

Answer 52

- lesion - external hemorrhoids - inflammation - rashes - excoriation