ASSESSMENT OF BREAST,

AXILLA AND GENITILIA

MS. BUSHRA IKRAM

LECTURER (FUCN)
 OBJECTIVES

 Discuss the history questions pertaining to male and female breast and Genitalia assessment.
 Perform a breast examination including axillary nodes and interpret finding.
 Discuss components of a genital exam on a male or female.
 Review components of a comprehensive reproductive history.
 List the changes in breast, male & female genitalia that are characteristics of aging.
 Document the findings.
 STRUCTURE AND FUNCTION

• The breasts are paired mammary glands that lie over the muscles of the
anterior chest wall.
• Depending on their size and shape, the breasts extend vertically from the
second to the sixth rib and horizontally from the sternum to the mid-axillary
line .
• The female breast is an accessory reproductive organ with two functions:
• To produce and store milk that provides nourishment for newborns.
• To aid in sexual stimulation.

• The male breasts have no functional capability.

 CONT.…………

• For purposes of describing the location of assessment findings, the breasts are
divided into four quadrants by drawing horizontal and vertical imaginary lines
that intersect at the nipple.

• The upper outer quadrant, which extends into the axillary area, is referred to
as the tail of Spence.

• Most breast tumors occur in this quadrant

 LYMPH NODES

• The major axillary lymph nodes consist of the anterior (pectoral), posterior
(subscapular), lateral (brachial), and central (mid-axillary) nodes.

• The anterior nodes drain the anterior chest wall

and breasts.
• The posterior chest wall and part of the arms are
drained by the posterior nodes.
• The lateral nodes drain most of the arms
• The central nodes receive drainage from the anterior,
posterior, and lateral lymph nodes
THE NURSING HEALTH HISTORY

History of Present Health Concern

• Have you noticed any lumps or swelling in your breasts?

• If so, where?

• When did you first notice it?

• Has the lump grown or swelling increased?

• Is the lump or swelling associated with other problems?

• Does the lump or swelling change during your menstrual cycle?

CONT. ………..

• Lumps may be present with benign breast disease (fibrocystic breast

disease), fibroadenomas, or malignant tumors.
• Premenstrual breast lumpiness and soreness that subside after the end
of the menstrual cycle may indicate benign breast disease (fibrocystic
breast disease).
• Have you noticed any lumps or swelling in the underarm area?
• Breast tissue and lymph nodes in the axilla may become enlarged,
appearing as lumps or swelling with fibroadenomas, infections, and
breast cancer.
 CON …………

• Have you noticed any redness, warmth, or dimpling of your breasts?

• Any rash on the breast, nipple, or axillary area?

• Redness and warmth indicate inflammation.

• A dimpling or retraction of the nipple or fibrous tissue may indicate breast
cancer.

• Have you noticed any change in the size or firmness of your breasts?
• A recent increase in the size of one breast may indicate inflammation or
abnormal growth.
• Do you experience any pain in your breasts?

• If yes, use COLDERRA/COLDSPA to further explore the symptom.

• Characteristics: Describe the pain (dull, aching, sharp).

• Onset: When did this first begin?

• Location: Point to the area where the pain occurs.

• Does it radiate to other areas?

• Duration: How long does it last? Does it recur? How often?

• Severity: Describe the pain on a scale of 1–10 (10 being the most
severe).

• Does it limit any of your activities you perform in a day’s time?

• Pattern: What do you do when you have this pain?

• What medications do you take to relieve the pain?

• Associated Factors: Does it occur at any specific time during your menstrual
cycle?
• Do you have any other symptoms when you have this pain (nipple discharge,
changes in color of breast, swelling)?
• Pain and tenderness of the breasts are common in fibrocystic breasts,
especially just before and during menstruation)
• Breast pain can also be a late sign of breast cancer.
• Do you have any discharge from the nipples? If so, describe its color,
consistency, and odor, if any.
• When did it start? Which nipple has the discharge?
• If the client reports any blood or blood-tinged discharge, she should be
referred to a physician for further evaluation.

• Sometimes, a clear benign discharge may be manually expressed from

a breast that is frequently stimulated.

• Certain medications (oral contraceptives, phenothiazines, steroids,

digitalis, and diuretics) are also associated with a clear discharge.
 PERSONAL HEALTH HISTORY

• Have you had any prior breast disease?

• Have you ever had breast surgery, a breast biopsy, breast implants, or breast
trauma? If so, when did this occur? What was the result?
• A personal history of breast cancer increases the risk for recurrence of cancer.
• Previous surgeries may alter the appearance of the breasts.
• Breast problems may occur with silicone breast implants. Trauma to the
breasts from sports, accidents, or physical abuse can result in breast tissue
changes.
• How old were you when you began to menstruate? Have you experienced
Menopause?
• Early menses (before age 13) or delayed menopause (after age 52) increases
the risk for breast cancer.
• Have you given birth to any children? At what age did you have your first
child?
• The risk of breast cancer is greater for women who have never given birth or
for those who had their first child after age 30.
• When was the first and last day of your menstrual cycle?
• This information will inform you if this is the optimal time to examine the
breasts. Hormone-related swelling, breast tenderness, and generalized
lumpiness are reduced right after menstruation.
Family History
• Is there a history of breast cancer in your family? If yes Who (sister, mother,
maternal grandmother)?
• A history of breast cancer in one’s family increases one’s risk for breast
cancer.
• Lifestyle and Health Practices
• Are you taking any hormones, contraceptives, or antipsychotic agents?
• Hormones and some antipsychotic agents can cause breast engorgement in
women.
• Hormones and oral contraceptives also increase the risk of breast cancer.
Haloperidol (Haldol), an antipsychotic drug, can cause galactorrhea (persistent
milk secretion whether or not the woman is breast-feeding) and lactation.
CONT. …………

• Do you live or work in an area where you have excessive exposure to

radiation, benzene, or asbestos?
• Exposure to these environmental hazards can increase the risk of breast
cancer.
• What is your typical daily diet? high-fat diet may increase the risk for breast
cancer.
• How much alcohol do you consume each day?
• How often do you use tobacco each day?
• Alcohol intake exceeding two drinks per day and tobacco use has been
associated with a higher risk for breast cancer
• How much coffee, tea, cola (or other forms of caffeine) do you consume each
day?
• Caffeine can aggravate fibrocystic breast disease.
• Do you engage in any type of regular exercise?
• If so, what type of bra do you wear when you exercise?
• Breast tissue can lose its elasticity if vigorous exercise (i.e., running,aerobics)
is performed without support for the breast. A well-fitting, supportive bra can
also reduce discomfort in the breasts during exercise.
• Do you examine your own breasts?
• Describe when you do this.
• Have you noted any changes in your breasts such as a lump, swelling,
skin irritation, or dimpling, nipple pain or retraction (turning inward),
redness or scaliness on nipple or breast skin, or discharge?
• If yes, have you reported this to your health care provider?
• Have you ever had your breasts examined by a health care provider?
• When was your last examination?
• Have you ever had a mammogram? If so, when was your last one?
(Women age 40 and older should have a screening mammogram every
year and should continue to do so for as long as they are in good
health.
• Breast awareness and self exam
SELF BREAST EXAMINATION

• Self breast examination (SBE) is a screening technique regularly

performed by a women both by feeling for anything suspicious in her
breast and by observing any changes.
• STEPS FOR SELF BREAST EXAMINATION
• Stand in front of the mirror (stand undressed in front of a mirror that is
wide enough to watch your entire chest. look for any changes from
normal
LOOK FOR

• Size
• Redness
• Skin changes
• Symmetry
• Nipple inversion (turning in )
• Bulging or dimpling
INSPECT BREASTS IN FOUR STEPS

• Step 1
• Both arms folded down : turn side to side to note any changes
• Step 2
• Both arms placed over your waist: place your hands on your wrist, and
turn side to side to note any changes.
• Step 3
• Both arms raised above head : place your hand behind your head and
again turn side to side an look for changes
• Step 4
• Slightly bending forward with arms over waist: place your hands at
your waist and bow toward the mirror letting the breasts fall forward.
Note any change in shape.
HAND MOVEMENTS

• Use the pads of three middle fingers to examine your breast tissue
move your fingers in small circular and regular movements to cover the
entire breast
• Don’t lift your fingers from your breast between palpations.
• Palpation perimeters.
• Move around the breast in up and downs pattern to examine all of your
breast tissue
• Breast palpation in triangle pattern
• Breast palpation in circular pattern
AXILLARY EXAMINATION

• Examination of the armpits for axillary lymph nodes

• Check for nipple discharge
• Squeeze your nipples to check for discharge
 PHYSICAL EXAMINATION

• Prepare for the breast examination by having the client sit in an upright
position.
• Explain that it will be necessary to expose both breasts to compare for
symmetry during inspection.
• One breast may be draped while the other breast is palpated.
• Be sensitive to the fact that many women may feel embarrassed to have their
breasts examined.
• The breasts are first inspected in the sitting position while the client is asked
to hold arms in different positions.
• The breasts are then palpated while the client assumes a supine position.
INSPECTION

• Inspect size and symmetry.

• Have the client disrobe and sit with arms hanging freely .
• Explain what you are observing to help ease client anxiety.
• Breasts can be a variety of sizes and are somewhat round and pendulous.
• One breast may normally be larger than the other.
• A recent increase in the size of one breast may indicate inflammation or an
abnormal growth.
• Inspect color and texture. Be sure to note client’s overall skin tone when
inspecting the breast skin.
• Note any lesions.
• Color varies depending on the client’s skin tone.
• Texture is smooth, with no edema.
• Linear stretch marks may be seen during and after pregnancy or with
significant weight gain or loss.
• Redness is associated with breast inflammation.
• The edema is caused by blocked lymphatic drainage.
• Inspect superficial venous pattern.
• Observe visibility and pattern of breast veins.
• Veins are more prominent during pregnancy.
• A prominent venous pattern may occur as a result of increased circulation due
to a malignancy.
• An asymmetric venous pattern may be due to malignancy.
• Inspect the nipples.
• Note the size and direction of the nipples of both breasts.
• Also note any dryness, lesions, bleeding, or discharge.
• Nipples are nearly equal bilaterally in size and are in the same location on
each breast.
• Nipples are usually everted. No discharge should be present.
• Inspect the areolas. Note the color, size, shape, and texture of the areolas
of both breasts.
• Areolas vary from dark pink to dark brown, depending on the client’s skin
tones. They are round and may vary in size.
• Inspect for retraction and dimpling.
• To inspect the breasts accurately for retraction and dimpling, ask the client to
remain seated while performing several different maneuvers.
• Ask the client to raise her arms overhead ; then press her hands against her
hips .
• Next ask her to press her hands together .
• These actions contract the pectoral muscles.
• The client’s breasts should rise symmetrically, with no sign of dimpling or
retraction.
• Finally, ask the client to lean forward from the waist .
• This is a good position to use in women who have large, pendulous
breasts.
• Breasts should hang freely and symmetrically.
• Restricted movement of breast or retraction of the skin or nipple
indicates fibrosis and fixation of the underlying tissues.
• This is usually due to an underlying malignant tumor.
PALPATION

• Palpate texture, elasticity ,tenderness and temperature.

• Palpation reveals smooth, firm, elastic tissue.
• Palpate for A generalized increase in nodularity and tenderness may be a
normal finding associated with the menstrual cycle or hormonal medications.
Breasts should be a normal body temperature.
• Painful, tender breasts may be indicative of fibrocystic breasts, especially right
before menstruation However, pain may also occur with a malignant tumor.
• Therefore, refer the client for further evaluation. Heat in the breasts of women
who have not just given birth or who are not lactating indicates inflammation.
• Palpate for masses.
• Note location, size in centimeters, shape, mobility, consistency, and
tenderness. Also note the condition of the skin over the mass.
• No masses should be palpated.
• If you detect any lump, refer the client for further evaluation.
• Fibrocystic breast tissue that feels ropy, lumpy, or bumpy in texture is referred
to as “nodular” or “glandular” breast tissue.
• Benign breast disease consists of bilateral, multiple, firm, regular, mobile
nodules with well-demarcated borders. Pain and fullness occurs just before
menses.
• Fibroadenomas are usually 1–5 cm, round or oval, mobile, firm, solid, elastic,
nontender, single or multiple benign masses found in one or both breasts.
• Milk cysts (sacs filled with milk) and infections (mastitis), may turn into
an abscess and occur if breastfeeding or recently given birth.

• If one’s breast is bruised from an injury, there will be a blood collection

that appears as a lump, which goes away in days or weeks, or the
blood may have to be drained by a health care provider.
• Palpate the nipples. Wear gloves to compress the nipple gently with your
thumb and index finger . Note any discharge.
• Palpate mastectomy or lumpectomy site.
• If the client has had a mastectomy or lumpectomy,it is still important to
perform a thorough examination.
• Palpate the scar and any remaining breast or axillary tissue for redness,
lesions, lumps, swelling, or tenderness
• Scar is whitish with no redness or swelling.
• No lesions, lumps, or tenderness noted.
• Redness and inflammation of the scar area may indicate infection.
 THE AXILLAE
INSPECTION AND PALPATION
• Inspect and palpate the axillae.
• Ask the client to sit up.
• Inspect the axillary skin for rashes or infection.
• No rash or infection noted.
• Redness and inflammation may be seen with infection of the sweat gland.
• Dark, velvety pigmentation of the axillae may indicate an underlying
malignancy.
• Hold the client’s elbow with one hand, and use the three finger pads of
your other hand to palpate firmly the axillary lymph nodes
BREAST SELF-EXAMINATION

• Finally, ask the client to demonstrate how she performs BSE if she
chooses to receive feedback on her technique and method.

• This should be offered as an option and the client’s choice accepted.

This time offers the nurse an opportunity to teach BSE.

• Give clients printed instructions .

The Male Breasts

INSPECTION AND PALPATION

• Inspect and palpate the breasts, areolas, nipples, and axillae.
• Note any swelling, nodules, or ulceration. Palpate the flat disc of undeveloped
breast tissue under the nipple. No swelling, nodules, or ulceration should be
detected.
• Soft, fatty enlargement of breast tissue is seen in obesity.
• Gynecomastia, a smooth, firm, movable disc of glandular tissue, may be seen
in one breast in males during puberty, usually temporary .However, it may
also be seen in hormonal imbalances, drug abuse, cirrhosis, leukemia, and
thyrotoxicosis.
FEMALE GENITALIA

FEMALE INTERNAL
FEMALE EXTERNAL GENITALIA
GENITALIA
• Vulva • Uterus
• Mons pubis
• Cervix
• Labia majora
• Labia minora • Ovaries
• Clitoris • Fallopian tubes
• Bartholin’s glands
• hymen
HISTORY

• Menstrual cycle/age of menarche

• Irregular vaginal bleeding
• Vaginal discharge
• Labial and genital lesions
• Date of last menstrual period
• Last pap smear? History of abnormal pap smear
• Pregnancy
• Menopausal symptoms
FEMALE GENITALIA EXAMINATION

• Inspection
• Skin color , hair distribution, labia majora, perineum area
• With the gloved hand separate the labia majora and inspect
• Clitoris
• Labia minora
• Urethral opening
• Vaginal opening
• Internal examination through speculum
• Vagina and cervix
DOCUMENTATION

• External genitalia : no swelling, lesion or discharge. No urethral

swelling or discharge
• Internal genitalia : vagina walls no bulging or lesions cervix with no
lesions, scant mucoid discharge observed.
 MALE GENITALIA

MALE EXTERNAL GENITALIA MALE INTERNAL GENITALIA

• Testes
• Penis
• Spermatic cord
• Frenulum • Epididymis
• Forskin • Vas deferns
• scrotum • Ejaculatory ducts
• Urethra
• Seminal vesicles
• Prostate gland
HISTORY OF MALE GENITALIA

• STE self testicular examination

• Scrotal and groin mass pain swelling and lesions
• Penile discharge
• Hesitancy of urine or decrease urine steam
• History of inguinal hernia or prostate enlargement
• Family history of prostate cancer
MALE GENITALIA EXAMINATION

• Inspection
• Penis :skin look for ulcers scars nodules or sign of inflammation
• Urethral meatus :position and discharge
• Scrotum: contour skin note any lump swelling ulcers sign of
inflammation.
• Compress the glans penis anterior posteriorly and palpate for
tenderness
MALE GENITALIA EXAMINATION

• Discharge
• Nodules
• Lump
• Palpate scrotum and observe for
• Testis size shape consistency tenderness nodules symmetry
• Inspect and palpate for inguinal hernias
• Instruct patient to bear down(lean) while palpating.
DOCUMENTATION

• No lesions, inflammation or discharge form penis scrotum

testis descended symmetrical no masses no inguinal hernia
Thank you