Head-To-Toe Assessment (Q. Breast)
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.
- The client is seated with her arms on her side.
- The client is seated with her arms abducted over the head.
- The client is seated and is pushing her hands into her hips, simultaneously eliciting contraction of the pectoral muscles.
- 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.
- The overlying the breast should be even.
- May or may not be completely symmetrical at rest.
- The areola is rounded or oval, with same color, (Color va,ies form light pink to dark brown depending on race).
- Nipples are rounded, everted, same size and equal in color.
- No “orange peel” skin is noted which is present in edema.
- The veins maybe visible but not engorge and prominent.
- No obvious mass noted.
- Not fixated and moves bilaterally when hands are abducted over the head, or is learning forward.
- 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.
- 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.