Head-To-Toe Assessment (Q. Breast)

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Inspection of the Breast

There are 4 major sitting position of the client used for clinical breast examination. Every client should be examined in each position.

1. The client is seated with her arms on her side.
2. The client is seated with her arms abducted over the head.
3. The client is seated and is pushing her hands into her hips, simultaneously eliciting contraction of the pectoral muscles.
4. The client is seated and is learning over while the examiner assists in supporting and balancing her.

• While the client is performing these maneuvers, the breasts are carefully observed for symmetry, bulging, retraction, and fixation.
• An abnormality may not be apparent in the breasts at rest a mass may cause the breasts, through invasion of the suspensory ligaments, to fix, preventing them from upward movement in position 2 and 4.
• Position 3 specifically assists in eliciting dimpling if a mass has infiltrated and shortened suspensory ligaments.

Normal Findings:

1. The overlying the breast should be even.
2. May or may not be completely symmetrical at rest.
3. The areola is rounded or oval, with same color, (Color va,ies form light pink to dark brown depending on race).
4. Nipples are rounded, everted, same size and equal in color.
5. No “orange peel” skin is noted which is present in edema.
6. The veins maybe visible but not engorge and prominent.
7. No obvious mass noted.
8. Not fixated and moves bilaterally when hands are abducted over the head, or is learning forward.
9. No retractions or dimpling.

Palpation of the Breast

• Palpate the breast along imaginary concentric circles, following a clockwise rotary motion, from the periphery to the center going to the nipples. Be sure that the breast is adequately surveyed. Breast examination is best done 1 week post menses.
• Each areolar areas are carefully palpated to determine the presence of underlying masses.
• Each nipple is gently compressed to assess for the presence of masses or discharge.

Normal Findings:

• No lumps or masses are palpable.
• No tenderness upon palpation.
• No discharges from the nipples.

NOTE: The male breasts are observed by adapting the techniques used for female clients. However, the various sitting position used for woman is unnecessary.

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• Head-To-Toe Assessment P. Thorax (Cardiovascular System) Inspection of the Heart The chest wall and epigastrum is inspected while the client is in supine position. Observe for pulsation and heaves or lifts Normal Findings: Pulsation of the apical impulse maybe visible. (this can give us some indication of the cardiac size). There
• Head-To-Toe Assessment N. Cranial Nerve I (olfactory Nerve) To test the adequacy of function of the olfactory nerve: The client is asked to close his eyes and occlude. The examiner places aromatic and easily distinguish nose. (e.g. coffee). Ask the client to identify the odor. Each side
• Head-To-Toe Assessment (M. Nose and Paranasal Sinuses) The external portion of the nose is inspected for the following: 1.     Placement and symmetry. 2.    Patency of nares (done by occluding nosetril one at a time, and noting for difficulty in breathing) 3.    Flaring of alaenasi 4.    Discharge The external nares are palpated for: 1.    Displacement of bone and cartilage. 2.    For tenderness and masses The internal nares are inspected by heperextending
• Head-To-Toe Assessment (E. Conjuctivae) The bulbar and palpebral conjunctivae are examined by separating the eyelids widely and having the client look up, down and to each side. When separating the lids, the examiner should exert no NO PRESSURE against the eyeball; rather, the examiner should hold the lids against the ridges of the bony orbit surrounding the eye. In examining
• Head-To-Toe Assessment (L. Ears) 1. Inspect the auricles of the ears for parallelism, size position, appearance and skin color. 2. Palpate the auricles and the mastoid process for firmness of the cartilage of the auricles, tenderness when manipulating the auricles and the mastoid process. 3. Inspect the auditory meatus or the