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.

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.

Complete Head to Toe Assessment with Videos

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