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Symptoms that signal a problem w/ the breasts
- Breast lump or mass - Pain or tenderness - Nipple discharge
Breast Cancer Significant Risk Profile
- Female > 50 - First-degree relative w/ breast cancer - Personal history of breast cancer
Breast Exam - Inspection
Breasts: Size, Shape, symmetry, color, lesions, venous pattern, dimpling or retraction Nipple & Areola: Nipple position & direction, discharge Axillae: Color, lesions, rashes
Maneuvers to screen for breast retraction
- Sitting w/ arms at side - Lift arms slowly over head - Push hands onto hips - Push palms of hands together - Lean forward (Larger Breasts)
Breast Exam - Palpation
Breasts: Consistency, masses, tenderness Nipple: Elasticity, masses, tenderness, discharge Lymph nodes: axillary, epitrochlear and clavicular
Nipple Palpation
Use thumb and forefinger to apply gentle pressure on nipple; note discharge - color and consistency
If masses/lumps on breast present, note:
Location, Size, Consistency, Discreteness, Redness, Temperature, Mobility, Nipple retraction, Overlying skin, Tenderness, Lymphadenopathy
Breast Palpation Patterns
Spokes-on-a-wheel Concentric Circles Vertical Strip
Palpation of Axillary Nodes
1. Down the chest wall in a line from the middle of the axilla 2. Anterior border of axilla 3. Posterior boarder of axilla 4. Along the inner aspect of the upper arm
Breast Exam Health History Questions
Breast: Pain, Lump, Discharge, Rash, Swelling, Trauma, Hx of breast disease, Surgery, Self-Care Behaviors SBE Mammogram Axilla: Tenderness, lump, or swelling; Rash
Breast Exam Preparation and Equipement
Preparation: Provide privacy, Use warm hands, Need adequate lighting, Teach BSE, Explain exam procedure, Position, Draping Equipment: Small pillow, Pamphlet for BSE
Male Breast Exam
Inspect: Chest wall, skin Palpate: Nipple, Breast tissue, axilla
Breast Developmental Considerations for the Elderly
- Adipose tissue increase - Subcutaneous fat may decrease - Glandular tissue atrophies - Suspensory ligaments relax - Chronic cystic disease
Abdominal Health Hx Questions
Appetite, Dysphagia, Food intolerance, Abdominal pain, Nausea/vomiting, Elimination pattern, Past abdominal history, Medications, Nutritional assessment, Changes in weight, Indigestion
Additional Abdominal Health Hx for adolescents
- Regular meals/ concerns about eating - Exercise/Activity patterns - Weight Loss - Body Image
Additional Abdominal Health Hx for elderly
- Acquisition of groceries - Meal preparation - Eat alone/Share meals
Structures in the Abdomen
Stomach, Large Intestines, Small Intestines, Liver, Gallbladder, Bladder, Pancreas, Kidneys
Abdominal Exam - Inspect
- Shape, contour size - Symmetry - Umbilicus - hernias - Skin-color, lesions, vein, hair distribution, hernias - Pulsation or movement, peristalsis - Demeanor
Abdominal Exam - Auscultate
Bowel sounds: All 4 quadrants, note frequency and pitch *Start w/ RLQ at the ileocecal valve area *Painful tender area auscultated last
Abdominal Exam - Abnormal Findings
Obesity, Air or gase, Ascites, Ovarian cyst, pregnancy, Feces, Tumor
Abdominal Exam - Palpation
Used to evaluate: - Size, location, consistency of organs - Screen for masses / tenderness - Evaluate tenderness, guarding Light = 1cm Deep = 5-8 cm
Measures to enhance abdominal muscle relaxation
1. Bend the person's knees 2. Keep your palpating hand low and parallel to abdomen 3. Teach person to breathe slowly 4. Keep your voice low and soothing 5. Emotive imagery 6. W/ ticklish person, keep their hands underneath your hands with own fingers curled over 7. Perform palpation after auscultation
Special procedures for abdominal exam
Rebound Tenderness (Blumberg's Sign): Push down slowly and deeply into abdomen, then quickly lift off. *Normal (Negative) = no pain on release *Positive = pain; appendicitis Inspiratory Arrest (Murphy's Sign): Hold your fingers under the liver border, ask the person to take a deep breath. *Normal (negative) = complete breathe without pain
Abnormal Bowel Sounds
Hyperactive: Loud, high pitched, rushing, tinkling sounds that signal increased motility Hypoactive (Absent): Follow abdominal surgery or with inflammation of the peritoneum
Referred Abdominal Pain
Risk Factors for Testicular Cancer
- Cryptorchidism - Age 16-35 - Family Hx of Testicular Cancer - Inguinal hernia during childhood - Maternal exposure to DES - Testicular cancer in other testicle
Signs of Testicular Cancer
- Hard, Fixed, non tender mass or nodules on testicle that are not visible - Scrotal swelling - Scrotal heaviness
Teaching Testicular Self Examination
- Explain rationale for the exam - Monthly TSE's permit earlier detection - Perform exam on the same day each month after a warm bath or shower
Conducting Testicular Exam
- Lift penis and check scrotum for any changes in shape, size, color *Left side normally hangs slightly lower - Check testes for lumps and masses - Locate epididymis at back of each testis - Use thumb and first finger to squeeze the spermatic cord gently - Gently roll testis between thumb and fingers - Testis should be egg-shaped and movable and feel rubbery, smooth and firm w/ no lumps - Both testes should be same size
Colorectal Cancer Risk Factors
- Greater than 45 years of age - Family Hx of colon cancer - Crohn's disease - Ovarian, breast, or endometrial cancer - Ulcerative colitis for more than 10 years - Diet high in beef and animal fats, diet low in fiber - Exposure to asbestos, acrylics and other carcinogens
Prostate Cancer Risk Factors
- Greater than 50 yrs - Black race - Increased animal fat - United States - Alcohol use - Family Hx - Occupation exposure to cadmium, fertilizers, exhaust, and rubber
Benign Prostatic Hypertrophy
- Caused by hormonal imbalance that leads to proliferation of benign adenomas - Slowly occludes urine output - Symptoms: Nocturia, hesitancy, polyuria
- Acute inflammation of the prostate gland - Usually caused by E Coli - Symptoms: Fever, chills, malaise, urinary frequency and urgency, urethral discharge, aching pain in perineal and rectal area
Examination of Stool
- Black Tarry: GI bleeding w/ blood partially digested; distinc malodor; must lose more than 50cc of blood to be considered Melena Black Non-tarry: From ingestion of iron or bismuth preparations Gray/Tan (Clay): Liver disease, absent bile pigment, obstructive jaundice Pale yellow: Greasy stool, increased fat content (steatorrhea) occurs w/ malabsoprtion syndrome, stools float Bright Red: Indicates rectal bleeding; when missed w/ feces indicates possible colonic bleeding Mucous: Jelly-like mucous shreds indicate inflammation
Abnormalities of the Anus
- Pilonidal cyst or sinus - Fissures - Internal/External hemorrhoids - Rectal Prolapse - Pruritis ani
Abnormalities of the Rectum
- Abscess - Polyp - Fecal Impaction - Colon Cancer
Pilonidal cyst or sinus
congenital disorder - not diagnosed until 15-30 years old. Hair containing cyst or sinus located midline over coccyx or lower sacrum. Either opens as a dimple with visible tut of hair, or is palpable as cyst. May have a palpable sinus tract when advanced stages
Anorectal Fisturla
abnormal passage from the inner anus/rectum out to skin surrounding the anus. Usually originates from a local abscess. Red, raised tract opening may drain serosanguinous or purulent matter when pressure is applied.
Painful longitudinal tear in the superficial mucosa at the ana margin. Often result from trauma eg. Passing a large, hard stool or from irritant diarrheal stools. Cause itching, bleeding, and pain.
- Varicose vein of hemorrhoidal plexus. - External and Internal - All hemorrhoids result from increased venous pressure as occurs with strainng at stool chronic constipation, pregnancy, obesity, chronic liver disease, or low fiber diets common in Western society
localized cavity of pus from infection in a pararectal space - usually extends from anal cyrpt. Persistent throbbing rectal pain. Named by the space it occupies eg. Perianal is superficial around the anal skin, ischiorectal occurs between the anus and ischial tuberosity (is uncommon)
protruding growth from the rectal mucous membrane - fairly common. May be pedunculated (on a stalk) or sessile (mounded). Usually biopsy to screen for a malignant growth.
Fecal impaction
Collection of heard, desiccated feces in the rectum. Results from decreased bowel motility (allows more H2O to be absorbed from the stool. Also occurs with retained barium from GI xrays. Patient may c/o constipation or of diarrhea as a fecal stream passes around the impaction. Opiods, prolonged use of laxatives or enemas may decrease sensitivity to urge to defecate and result in impactions
Colon Cancer
malignant neoplasm in the rectum is asymptomatic; in colon symptoms may be nonspecific. Importance of regular exams when increased age for risk is reached, or if any symptoms appear. About half of all rectal lesions are malignant
Pictures of Abnormalities of Anus
Pictures of Abnormalities of Rectum
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