Miscellaneous Flashcards
describe the steps of a breast exam
introduction
inspection; normal, press hands on hips, place hands over head
palpation; breast quadrants, axillary tail, axillary lymph nodes
conclude exam
describe the introduction of a breast exam
confirm patient details explain procedure explain the need for a chaperone allow them to ask any questions gain consent position the patient sitting upright on the side of the bed ask the patient to adequately expose their breasts ask about any lumps or pain
describe the inspection section of a breast exam
ask the patient to put their hands on their thighs
scars; lumpectomy, mastectomy
asymmetry
masses
nipple abnormalities; inversion, discharge, Paget’s disease
skin changes; scaling, erythema, puckering, peau d’orange
repeat inspection with the patient pressing their hands into their hips
observe if any masses move when the pectoralis muscle contracts; underlying tethering
arms behind the head and lean forward; expose entire breast, exaggerate asymmetry, skin dimpling, puckering
describe the palpation section of a breast exam
adjust the head of the bed to 45 degree and ask the patient to lie down
start on the asymptomatic breast first
put their hand behind their head
examine all 4 quadrants using a systematic palpation technique
palpate the axillary tail
nipple-areolar complex; compress the areolar tissue towards the nipple and inspect for discharge; colour, consistency, volume
elevate the breast
lymph nodes;
axilla; hold the patients arm and palpate both axillas
cervical and parasternal exam
describe the conclusion of a breast exam
explain that you are finished thank the patient allow them to get dressed summarise findings other investigations; mammography, ultrasound, biopsy (FNA)
what questions should be asked in the history of presenting complaint in a breast history?
pain; SOCRATES related to the menstrual cycle; fibrocystic change nipple discharge or bleeding nipple inversion erythema ulceration dimpling (peau d'orange) fever weight loss malaise lymphadenopathy bone pain; metastases ideas, concerns and expectations
what questions should be asked in the PMHx of a breast history?
medical conditions; treatment, control of disease, complications, hospital admission
early menopause
late menopause
treatment with continuous combined HRT or OCP
breastfeeding history
what questions should be asked in the FHx of a breast history?
breast cancer
ovarian cancer
bowel cancer
at what ages these diseases developed
what questions should be asked in the SHx of a breast history?
alcohol; increases breast cancer risk
smoking; increases breast cancer risk
IV drug use; increases abscess risk
what questions should be asked in the history or presenting complaint of a gynaecological history?
1st day of last menstrual period menarche duration of cycle and period blood loss volume post-coital bleeding intermenstrual bleeding pain; before/during period, SOCRATES vaginal discharge painful intercourse obstetric history contraceptive history psychosexual history; lack of libido, failure to achieve orgasms associated symptoms; mood alteration, bloating, skin changes, breast heaviness/tenderness, headaches, flushing, sweats, vaginal dryness, fatigue, insomnia, increased facial hair growth
what questions should be asked in the PMHx and FHx of a gynaecological history?
cervical smear history; last smear, results
neck of womb/cervical operations
early menopause
polycystic ovarian syndrome
premenstrual tension
describe the steps of urinalysis
check patient details
inspect colour and clarity of sample
ensure testing strips are not out of date
remove testing strips and close lid
immerse strip fully into sample for 1-2s
tap any excess urine off strip
keep strip horizontal
compare colour on strip to colour code on contour
ensure the strip does not touch the container
dispose in clinical waste bag
consider sending sample off for further tests; urinary culture, antibiotic sensitivities
wash hands and record results
