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Breast and Female Genitalia Assessment — Transcript

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0:00Hello. So, we're moving on to discuss
0:05assessment of the breasts, axilla, and
0:08female genitalia.
0:10And so, these assessments are really
0:12important components of a comprehensive
0:14health exam, and they play a critical
0:16role in health promotion, early
0:18detection of disease, and patient
0:20education.
0:22And again, many patients are going to
0:23feel anxious, embarrassed, or vulnerable
0:26during these assessments, so it's
0:27essential that we establish trust,
0:30maintain professionalism, explain each
0:32step of the exam, and provide privacy
0:34and dignity throughout the assessment
0:36process.
0:37So, we're going to review relevant
0:40anatomy and physiology, subjective and
0:42objective assessment techniques, and
0:44age-related
0:46considerations, health promotion
0:48strategies, and then common common
0:50abnormal findings that may require
0:51further evaluation. So, by the end of
0:54this presentation, you should be able to
0:55identify normal and abnormal assessment
0:57findings, and understand the nursing
0:59implications of those findings.
1:04Along with these learning objectives,
1:10So, before performing a female genital
1:12assessment, it's important to explain
1:14the procedure and obtain informed
1:16consent. You're again going to provide
1:18privacy, and we're going to use a
1:20trauma-informed approach. And many
1:22patients are going to feel anxious or
1:24embarrassed during this exam, so
1:26maintaining dignity and professionalism,
1:29as well as communication, is essential
1:30throughout.
1:32So, we have some structures here I'm
1:34going to highlight. So, we have the
1:36labia majora,
1:38which are the larger outer folds of the
1:40skin that provide protection for the
1:42underlying structures. And inside these
1:45are the labia minora, which are thinner
1:48folds that surround the vestibule. It's
1:50important to recognize that significant
1:52variation in size, shape, color, and
1:55symmetry of the labia is normal.
1:58Then we have the urinary meatus is the
2:00opening of the urethra. It's located
2:02between the clitoris and the vaginal
2:05opening.
2:06During assessment, nurses should observe
2:08for redness, swelling, discharge, and
2:11signs of irritation.
2:14Then we have the perineum, which is the
2:17area between the vaginal opening and the
2:19anus. And so assessment of this area is
2:22particularly important following
2:24childbirth, surgery, trauma, or when
2:27evaluating skin integrity.
2:29And finally, the anus should be expected
2:31or inspected for skin integrity,
2:34hemorrhoids, lesions, fissures, or any
2:37signs of infection.
2:39And we're when we're assessing the
2:40external genitalia, we should inspect
2:43for color and pigmentation, symmetry,
2:47hair distribution, any lesions, ulcers,
2:50or masses, swelling or edema, discharge,
2:53and signs of infection or trauma.
2:56Normal findings include intact skin,
2:58absence of lesions, no unusual
3:00discharge, and structures that are free
3:02of tenderness, swelling, or
3:04inflammation. And remember that normal
3:06appearance varies greatly among
3:08individuals based on age, hormonal
3:11status, childbirth birth history,
3:14ethnicity, and individual anatomy.
3:17So, the goal is to identify
3:18abnormalities while also respecting
3:20normal anatomical variation.
3:26So, this slide illustrates the major
3:28internal reproductive organs and their
3:30relationship to surrounding structures.
3:32So, the vagina is a muscular elastic
3:35canal extending from the vaginal opening
3:38to the cervix, and it serves as a
3:40passageway for menstrual flow, sexual
3:42intercourse, and childbirth. And the
3:45vaginal walls are normally pink, moist,
3:47and free of lesions. And at the upper
3:49end of the vagina is a cervix, which is
3:51the lower portion of the uterus. And the
3:54cervix contains the cervical canal
3:57connecting the uterus to the vagina.
3:59And during a pelvic exam, the cervix is
4:02assessed for color, position, lesions,
4:05discharge, and abnormalities.
4:08The uterus is a hollow muscular organ.
4:10It's located between the bladder and
4:12rectum. It's primary function is to
4:14support fetal development during
4:17pregnancy. The upper rounded portion is
4:20called the fundus, while the main body
4:22is referred to as the corpus. Uh the
4:25uterine wall contains three layers. We
4:28have the endometrium,
4:30which thickens and sheds during
4:32menstruation, myometrium, which is the
4:35thick muscular layer responsible for
4:37uterine
4:38contractions, and the perimetrium, which
4:42is the outer protective layer.
4:45Um so, extending laterally from the
4:47uterus are the fallopian tubes, which
4:49transport ova from the ovaries toward
4:52the uterus.
4:54Um and then fertilization most commonly
4:57occurs within the fallopian tube.
5:00The ovaries are paired reproductive
5:02organs that produce that ova and secrete
5:04hormones, including estrogen and
5:06progesterone.
5:08And although the ovaries are important
5:10structures, they are often difficult to
5:12palpate during a routine exam, um
5:14especially in postmenopausal
5:16individuals. But notice the close
5:18relationship between the reproductive
5:20organs and neighboring structures, such
5:22as the bladder, urethra, ureters, and
5:24rectum. So, understanding this anatomy
5:27helps explain symptoms such as urinary
5:29frequency, pelvic pressure,
5:31constipation, or pain that may occur
5:34within reproductive conditions.
5:37And during a comprehensive pelvic exam,
5:39health care providers may evaluate the
5:41cervix, uterus, and ovaries through a
5:43speculum and bimanual examinations.
5:47So, as nurses, important to understand
5:49the purpose of these assessments, assist
5:51with patient positioning and comfort,
5:53and then recognizing normal versus
5:55abnormal findings.
6:00So, to understand the female
6:01reproductive health, it's important to
6:03understand the hormonal feedback system
6:05that regulates the menstrual menstrual
6:07cycle and reproductive function. Um this
6:10process involves communication between
6:12the hypothalamus,
6:14anterior pituitary gland, and ovaries.
6:17It's often referred to as the
6:19hypothalamic pituitary ovarian axis, or
6:22HPO for short. Uh the process begins
6:26with the hypothalamus, which secretes uh
6:29gonadotropin-releasing hormone.
6:32Gonadotropin, sorry. And this stimulates
6:35the anterior pituitary gland to release
6:37two important hormones. So, we have
6:39follicle-stimulating hormone and
6:42luteinizing hormone. Uh
6:44follicle-stimulating hormone primarily
6:46stimulates the growth and maturation of
6:48ovarian follicles. And as follicles
6:51mature, they begin producing estrogen.
6:54Um and then we have luteinizing hormone,
6:56which works alongside uh
6:58the follicle-stimulating hormone, but it
7:01plays a particularly important role in
7:04triggering ovulation. So, a surge in
7:07luteinizing hormone can cause the mature
7:09follicle to release an ovum, which is
7:12the process we know as ovulation.
7:16And the ovaries respond to those
7:18hormones by producing the hormones
7:21estrogen and progesterone. And estrogen
7:24is responsible for development of female
7:26secondary sex characteristics,
7:28growth and thickening of the endometrium
7:31during the first half of the menstrual
7:33cycle, and regulation of the menstrual
7:36cycle through feedback mechanisms.
7:39Progesterone becomes the dominant
7:40hormone after ovulation. Its primary
7:42role is to prepare and maintain the
7:44endometrium for possible implantation of
7:48a fertilized egg.
7:49But if fertilization does not occur,
7:51estrogen and progesterone levels are
7:53going to decline, which causes the
7:55endometrium [clears throat] lining to
7:56shed and results in menstruation.
7:59So the system functions through a
8:02delicate balance of positive and
8:04negative feedback loops. And any
8:06disruptions anywhere along the pathway
8:08can lead to menstrual
8:11irregularities,
8:12infertility, or hormone hormonal
8:15disorders.
8:16So very sensitive.
8:21Let's move on to breast exam. So before
8:24performing a breast assessment and exam,
8:27it's important to understand the
8:28underlying anatomy. So knowledge of
8:30breast structures helps us distinguish
8:33normal findings from abnormalities, and
8:35it helps us understand how disease
8:37processes affect the breast. So let's
8:40review the major structure shown on the
8:41slide. We have the nipple, which is
8:43located near the center of the breast.
8:45And during assessment, we observe the
8:47nipples for symmetry, position,
8:49inversion, discharge, scaling, or
8:52lesions. Surrounding the nipple is the
8:55areola, the pigmented area of skin.
8:59We're are looking at color and size,
9:01which can vary widely among individuals,
9:03and it may change during pregnancy due
9:05to hormonal influences.
9:08And within the areola, these are we have
9:10small sebaceous glands called Montgomery
9:13glands. And these glands secrete an oily
9:16substance that lubricates and protects
9:18the nipple, particularly during
9:20breastfeeding.
9:22And then small raised bumps in this area
9:24are also a normal finding.
9:27And the breast is supported by fibrous
9:29connective tissue, including Cooper's
9:31ligaments. And these ligaments help
9:32maintain breast shape and structure.
9:35When breast cancer invades ligaments,
9:38uh, we may sometimes see dimpling or
9:41retraction of the skin.
9:44The glandular tissue, this is
9:46responsible for milk production
9:47production and transport. This tissue
9:50consists of lobes, lobules, and ducts
9:52that converge towards the nipple.
9:55Uh, much of the breast nodularity comes
9:58from normal glandular tissue,
10:00particularly in young women.
10:02And within the glandular tissue are
10:05these acini which are the milk-producing
10:07cells. Uh, during pregnancy and
10:09lactation, hormonal stimulation causes
10:12these cells to enlarge and become active
10:14in milk product milk production.
10:17The breast also contains a rich network
10:20of arteries and veins, which provide
10:22blood supply and support lactation.
10:25Increased vascularity may become visible
10:27during pregnancy and breastfeeding. And
10:29one of the most clinically important
10:31structures shown on the slide is the
10:32lymphatic system. So, approximately 75%
10:36of breast lymphatic drainage occurs
10:39through the axillary lymph nodes.
10:41Uh, the remaining drainage occurs
10:43through internal mammary and other
10:45regional lymph nodes.
10:48Uh, this lymphatic drainage pattern is
10:51important because breast cancer often
10:53spreads first through the lymphatic
10:55system. So, for this reason, axillary
10:58lymph node assessment is routine part of
11:01every breast examination. Make sense?
11:07So, to accurately communicate breast
11:09assessment findings, health care
11:11providers use standardized breast
11:13landmarks. And these landmarks allow
11:15clinicians to precisely describe the
11:18location of masses, tenderness, skin
11:20changes, or other abnormalities, and
11:22ensure clear communication among members
11:24of the health care team. So, there are
11:26two common methods used to describe
11:28breast findings. The first method
11:30divides the breast into four quadrants.
11:33We have upper outer, upper inner, lower
11:36outer, and lower inner quadrants. And an
11:39additional area called the tail of
11:41Spence, this extends from the upper
11:44outer quadrant into the axilla.
11:46Uh
11:46>> [snorts]
11:46>> this region contains breast tissue and
11:48lymphatic structures and it's clinically
11:50important because
11:52um
11:52like we said, many breast cancers
11:54develop in this area. So, therefore,
11:55assessment of the tail of Spence and
11:58axillary lymph nodes should always be
12:00included during a breast examination.
12:03The second method uses the face of a
12:05clock. So, in this system, the nipple
12:07serves as the center of the clock. The
12:09findings are described by their clock
12:11position and distance from the nipple.
12:12For example, a nurse might document a 1
12:16cm firm mobile mass located at the 2:00
12:20position, 3 cm from the nipple. Or
12:23tenderness noted in the lower outer
12:26quadrant of the left breast. So, using
12:28consistent landmarks is going to help us
12:30improve documentation accuracy and allow
12:33providers to compare findings over time.
12:39So, one of the most important roles of
12:40the nurse during a breast assessment is
12:43recognizing findings that require prompt
12:45follow-up and further evaluation. So,
12:48patients present with a variety of
12:49breast concerns including trauma,
12:51infection, pain, masses, or nipple
12:53discharge. And while many breast
12:55conditions are benign, it's important to
12:57remember that breast cancer can
12:58sometimes mimic inflammatory or
13:01infectious conditions making careful
13:03assessment really essential. So, common
13:05findings that should prompt additional
13:07investigation, a new lump or mass, it's
13:11one of the most significant findings.
13:13Although many breast masses are benign,
13:16any new mass should be further evaluated
13:18particularly if it's firm, fixed,
13:21irregular, or persists after menstrual
13:23cycle.
13:24Breast swelling or asymmetrical
13:26enlargement, this may indicate
13:28infection, inflammation, trauma, or
13:31malignancy. So, changes in the skin,
13:33such as dimpling as well, puckering, or
13:35irritation, these are concerning. Again,
13:38we talked about how they may indicate
13:39involvement of the underlying connective
13:41tissue and lymph nodes.
13:43Um dimpling occurs when a lesion pulls
13:46on those Cooper's ligaments,
13:49um which creates that indentation in the
13:51skin.
13:53Breast pain, this is often associated
13:55with benign as well, um but persistent
13:58localized breast or nipple pain warrants
14:01further assessment, especially when
14:02accompanied by other abnormal findings.
14:06Nipple retraction is another important
14:08finding, although some individuals have
14:09lifelong inverted nipples, a newly
14:12retracted nipple should always be
14:13evaluated because it may result from an
14:15underlying mass pulling on the breast
14:17tissue.
14:19Any changes involving the nipple or
14:21breast skin, including redness, scaling,
14:23crusting, thickening, or ulceration may
14:25indicate inflammatory conditions,
14:27infection,
14:29or less commonly malignancy.
14:32Um finally, nipple discharge should
14:34always be assessed carefully. Important
14:36questions include, is the discharge
14:38spontaneous or is it expressed? Is it
14:41unilateral or bilateral?
14:44What color is it? Is it bloody, serous,
14:46milky, or purulent?
14:48Um spontaneous unilateral bloody
14:51discharge is particularly concerning and
14:53it requires prompt evaluation.
14:58So, before beginning the physical exam,
15:00it's important to gather a thorough
15:02health history, as we know. Um the
15:04subjective assessment is often going to
15:06provide us valuable information that's
15:08going to guide the physical exam and it
15:10help us identify risk factors for breast
15:12disease.
15:13Um so, breast discomfort, masses, or
15:16nipple discharge, we want to ask the
15:18patient about any breast pain,
15:20tenderness, lumps, or changes they have
15:22noticed. If pain is present, we're
15:24assessing the location, duration,
15:26severity, and relationship to the
15:28menstrual cycle.
15:30Um for nipple discharge, we're
15:31determining whether it again,
15:32spontaneous or expressed, unilateral or
15:35bilateral, noting the color and
15:37consistency.
15:40Any history of breast surgeries, we want
15:42to ask about previous breast surgeries
15:43including biopsies, lumpectomies,
15:46mastectomies, breast augmentation, or
15:49reduction procedures. Um surgical
15:51history may alter breast anatomy and
15:53affect assessment findings.
15:56Menstrual, pregnancy, and lactation
15:58history, so those hormonal hormonal
16:00fluctuations throughout life include
16:02breast or influence breast tissue. So
16:05we're asking about age of um
16:08menarche, which is
16:10the start of um
16:13a young woman's period, menopausal
16:16status, pregnancies, breastfeeding
16:18history, and current menstruation
16:20patterns.
16:22Any breast changes associated with
16:24pregnancy and lactation, these are often
16:26normal, but should also be assessed.
16:29Hormone replacement therapy and hormonal
16:31contraceptives, we're determining
16:33whether the patient currently uses or
16:34has previously used hormonal replacement
16:36therapy or hormonal contraceptives.
16:40Exogenous hormones can influence breast
16:42tissue density, and they may affect
16:44breast cancer risk.
16:47Personal history of breast trauma and
16:48self-care behaviors, we want to ask
16:50about any recent breast injury, trauma,
16:53which can cause pain, bruising, or fat
16:54necrosit or fat necrosis that may mimic
16:57a mass. We want to assess health
17:00promotion behaviors such as breast
17:02self-awareness, um routine screening,
17:04and uh mammography adherence.
17:10Family history, this is a significant
17:12risk factor for breast cancer. We want
17:13to ask about first-degree relatives with
17:16breast, ovarian, or related cancers and
17:19determine whether the patient or family
17:21members have tested positive for the
17:23BRCA 1 and 2 gene mutations, which
17:27substantially increase breast and
17:29ovarian cancer risk.
17:35Um assessment risk factors.
17:38So, we're asking about past medical
17:40history, any previous breast conditions
17:44such as cysts, fibroadenomas, atypical
17:47hyperplasia, or breast cancer. We're
17:49discussing reproductive history
17:51including age um that they started
17:55um having a period and menopause
17:58as prolonged lifetime exposure to
18:01estrogen may increase increase breast
18:03cancer risk. So, the younger you were
18:06getting uh your period,
18:09um the more
18:11increased breast cancer risk you you
18:13could have.
18:17Um
18:19we also want to determine whether the
18:20patient has undergone chest radiation
18:22therapy, particularly at a young age.
18:24This increases future breast cancer
18:26risk.
18:28And then lifestyle and personal habits,
18:29we're assessing alcohol consumption as
18:31increased alcohol intake is associated
18:34with higher risk of breast cancer. We
18:36want to discuss physical activity
18:38levels, weight management, and dietary
18:40habits, evaluate tobacco use and
18:42exposure to environmental risk factors,
18:45encourage healthy lifestyle behaviors
18:47that support overall breast health and
18:49reduce cancer risk.
18:52Medications, we want to review any
18:53current and past use of hormonal
18:56replacement therapy and hormonal
18:57contraceptives. We want to ask about
19:00medications that may affect hormone
19:01levels or cause breast changes and
19:04determine whether the patient has
19:05noticed breast symptoms associated with
19:07medication use.
19:09And then finally, obtain a detailed
19:11family history, especially again among
19:13first-degree relatives such as parents,
19:16siblings, and children. We want to ask
19:18about breast cancer, ovarian cancer,
19:20prostate, pancreatic, and known genetic
19:23mutations.
19:25And determine whether any family members
19:27have tested positive again for the BRCA1
19:29and BRCA2 mutations.
19:36So, one of our
19:37>> [sighs]
19:37>> most important roles is promoting breast
19:39health through education, risk
19:41reduction, and early detective detection
19:44strategies.
19:46Um so, breastfeeding promotion. Um
19:48national and global health initiatives
19:50continue to promote breastfeeding
19:52because of its health benefits for both
19:54infants and mothers. So, breastfeeding
19:57provides optimal nutrition, supports
19:58infant immune function, and promotes
20:01maternal-infant bonding. So, for
20:03mothers, breastfeeding has been
20:04associated with a reduced risk of breast
20:06and ovarian cancers. And so, we can
20:09support breastfeeding by providing
20:10education, encouragement, and referrals
20:13to lactation resources when needed.
20:16Genetic counseling for individuals at
20:19increased risk. So, patients with a
20:20strong family history um may benefit
20:23from genetic counseling, which helps
20:25individuals understand their personal
20:26cancer risk and determine whether
20:29genetic testing may be appropriate.
20:32Reducing breast cancer mortality. So,
20:34early detection remains one of the most
20:36effective ways to reduce breast cancer
20:38deaths.
20:39Um we should encourage adherence to
20:41age-appropriate screening
20:42recommendations including mammography
20:45and clinical follow-up when
20:47abnormalities are identified.
20:50Um we should focus on recognizing breast
20:52changes and promptly reporting concerns
20:55to their health care provider. And then,
20:57teaching self um breast examination.
21:02Historically, women were routinely
21:03taught to perform monthly self breast
21:05examinations, but current evidence
21:08doesn't demonstrate that routine monthly
21:11um breast examinations alone reduces
21:13breast cancer mortality. So, many
21:15organizations no longer recommend that.
21:19Instead, [clears throat] they're
21:19emphasizing a strict monthly exam.
21:22Um
21:24current current
21:26Oh my god. Instead of that strict
21:28monthly exam, current recommendations
21:30are focusing on breast self-awareness.
21:33So, that means becoming really familiar
21:35with the normal appearance and feel of
21:37one's breasts and promptly reporting any
21:39changes.
21:47So, patients seek breast health care for
21:50a variety of reasons, and as nurses, we
21:52must recognize common symptoms,
21:54understand age-related changes, and
21:55provide culturally sensitive care. Um
21:59So, common symptoms that um patients
22:02might come in with, breast pain. This is
22:05common a common complaint, and it's
22:07often benign. The pain may be uh
22:10cyclical. It could occur with hormonal
22:12changes during the menstrual cycle or
22:14non-cyclical.
22:16Um so, we're assessing the location,
22:17duration, severity, and relationship to
22:19menstruation.
22:21So, although breast pain alone is rarely
22:23associated with cancer, persistent or
22:26localized pain should be evaluated.
22:29Rash, we're assessing the skin for
22:30redness, scaling, crusting, or
22:32irritation. Uh rashes may result from
22:34dermatitis, fungal infections, allergic
22:37reactions, or inflammatory conditions.
22:41Lumps, like we talked about, most breast
22:45masses are benign, but any new masses
22:47should be assessed carefully.
22:49Swelling, breast swelling may occur
22:51during um hormonal changes, could be an
22:54infection, trauma, pregnancy, or
22:56malignancy. So, we're comparing both
22:58breasts for symmetry and changes in
23:00contour.
23:02Nipple discharge, we're asking whether
23:04the discharge is again spontaneous or
23:06expressed, unilateral or bilateral, and
23:09noting the color.
23:11Trauma, any breast trauma can result in
23:13bruising, tenderness, swelling, or fat
23:15necrosis. So, obtaining details
23:17regarding the mechanism and timing of
23:19the injury.
23:22Special populations like in pregnancy,
23:24there are significant breast changes
23:26that occur
23:27um because of those hormonal influences.
23:29So, the breast typically enlarge, um
23:32become more vascular, and may develop
23:33prominent veins. The areola may darken,
23:37Montgomery glands become more
23:39noticeable, colostrum production may
23:42begin before delivery.
23:45Adolescence, um so breast development is
23:47a normal part of puberty. So, temporary
23:50asymmetry between breasts is common
23:52during this phase of life. Um breast
23:55buds may be tender during development.
23:57So, education should focus on normal
24:00growth patterns and body image for
24:02adolescents.
24:03Older adults, aging results in decreased
24:06glandular tissue and increased fatty
24:08tissue. So, breasts may become less firm
24:10and more
24:12um
24:13pendulous due to decreased elasticity.
24:17So, the nipples may flatten, the skin
24:18may become thinner.
24:20Um so, we're continuing to encourage
24:22age-appropriate screening and breast
24:24awareness in older adults.
24:26And then cultural beliefs may influence
24:28attitudes toward towards breast
24:30examinations, modesty, screening, and
24:32health care seeking behaviors. So, some
24:34patients may prefer like a same-gender
24:37health care provider. Others may have
24:39concerns related to privacy or body
24:41exposure or discussing reproductive
24:43health. So, we're using our culturally
24:45sensitive communication, we're avoiding
24:46assumptions, and we're asking our
24:48patients about their preferences.
24:54So, after completing the health history,
24:56we're going to gather objective data
24:58through inspection and when appropriate
25:00palpation.
25:01Um
25:04So, inspection of the breast is the
25:06first step of the physical exam. The
25:08patient should be seated with adequate
25:09exposure of both breasts. We're
25:11observing for symmetry in size, contour
25:13and shape, skin color and condition,
25:16nipple position and appearance, visible
25:18masses or swelling.
25:23We want them to raise both arms
25:25overhead, press our hands against hips,
25:28lean forward if able. So, these position
25:31changes may reveal dimpling or
25:34retraction caused by underlying lesions.
25:37Um a complete breast exam includes a
25:39health history, inspection, palpation of
25:42the breast tissue, palpation of regional
25:44lymph nodes, partic- particularly those
25:47axillary nodes. And during palpation,
25:49we're using the finger pads of the
25:51middle three fingers with light to
25:52moderate and then deep pressure. And
25:55we're assessing all breast tissue
25:57including the tail of Spence extending
25:59into the axilla. We're noting any
26:01masses, tenderness, thickening, or
26:03abnormalities. If we do identify a mass,
26:06we're documenting the location, size,
26:09shape, consistency, if it is mobile
26:11mobile or immobile,
26:14uh tenderness and distinctness
26:17of borders.
26:18Transillumination, um this is an
26:20advanced assessment technique. It's
26:22occasionally used to help distinguish
26:24between a fluid-filled cyst and a solid
26:26mass. So, a bright light is placed
26:28against the tissue in a darkened room.
26:31Fluid-filled structures may allow light
26:33to pass through more readily, whereas
26:35solid masses generally do not.
26:37Um transillumination is not commonly
26:39used during a routine clinical practice
26:41um
26:42because it more accurate imagery imaging
26:45uh modalities are available.
26:48And then, diagnostic imaging and
26:50procedures. So, mammography, this uses
26:52low-dose x-rays to evaluate breast
26:54tissue. It's considered the primary
26:56screening tool for early detection of
26:58breast cancer.
26:59Um then we have breast ultrasound. It's
27:02often used to further evaluate findings
27:04identified on physical exam or
27:06mammography.
27:08Um it's particularly useful for
27:10distinguishing fluid-filled masses um
27:13from solid ones.
27:16And then MRI, this is going to provide
27:18us highly detailed imaging of breast
27:20tissue. It's often used for high-risk
27:22patients, further evaluation of
27:24suspicious findings, and assessment of
27:26implant integrity.
27:29And then aspiration or biopsy, sometimes
27:32fine fine needle aspiration may be used
27:34to remove fluid from a cyst or obtain
27:37cells for analysis. Uh core needle
27:39biopsy, this obtains a tissue sample for
27:43definitive diagnosis if we're looking
27:45for breast cancer. Um but biopsy remains
27:47the gold standard for determining
27:49whether a suspicious lesion is benign or
27:52malignant.
27:54Equipment needed, ruler marked in
27:58centimeters. So, a centimeter ruler is
28:00used when measuring palpable masses or
28:02lesions.
28:03Um accurate measurements is going to
28:04allow for precise documentation and
28:07comparison over time.
28:10A small pillow or folded towel is placed
28:13under the shoulder on the side being
28:15examined when the patient is supine, and
28:18this helps flatten the breast tissue
28:19against the chest wall,
28:21making palpation more effective and
28:23comfortable.
28:24And then patient education materials,
28:26educational pamphlets or handouts may be
28:29provided to reinforce our teaching about
28:31breast self-awareness, screening
28:33recommendations, and follow-up care.
28:35Gloves, of course, should always be
28:37using standard precautions.
28:39Um
28:41adequate lighting, essential for
28:44inspection.
28:47And then patient preparation. We're
28:48explaining this procedure to our
28:50patient. We're getting consent. We're
28:52using clear communication.
28:55Um
28:56we're providing privacy.
28:59Exposing only the area being examined,
29:02using gowns and drapes appropriately.
29:05We want to try to just create a
29:07comfortable environment that improves
29:08the quality of the examination because
29:10the patient is feeling less anxious.
29:14And considering the timing within the
29:15menstrual cycle, so hormonal
29:17fluctuations are going to affect breast
29:19tissue.
29:20Um so for menstruating individuals,
29:22breast exams are ideally performed 5 to
29:247 days after menstruation begins.
29:27Um this is when hormonal stimulation and
29:29breast tenderness are at their lowest.
29:31So during this time, breast tissue is
29:32generally less nodular and easier to
29:35assess. So if a patient reports a lump,
29:38uh evaluation we're not going to delay
29:40that at that time
29:42because of the cycle, but ideally um the
29:45timing that I just spoke about is
29:48is helpful.
29:57So the comprehensive breast assessment
29:59is included both inspection and
30:01palpation. So
30:09breasts exposed to female hormones, um
30:13we'll start with inspection. So we're
30:14beginning with the patient seated and
30:16adequately draped. We're inspecting both
30:19breasts again for symmetry, size, and
30:21contour, skin color and condition, any
30:24visible masses or swelling, nipple
30:26position and appearance. And we're
30:28observing the breasts in several several
30:30positions. Again, arms relaxed at the
30:32side, arms raised overhead, hands
30:35pressed against the hips, leaning
30:37forward if able. So these position
30:40changes, they're going to reveal
30:42subtle dimpling, retraction, or fixation
30:44of underlying tissue. And then
30:46palpation, we're positioning the patient
30:48supine with a small pillow under the
30:50shoulder being examined, and the arm
30:53raised overhead. We're using the finger
30:55pads of the middle three fingers,
30:57applying light, moderate, and deep
30:58pressure. We're palpating using a
31:00systemic approach.
31:02Um
31:05and we're including the entire breast
31:06tissue, the tail of Spence, and the
31:08axillary lymph nodes.
31:10Now, we have breasts to male hormones.
31:13So, male breast cancer is uncommon, but
31:15it does occur.
31:17So, an assessment is
31:19going to include inspection and
31:21palpation of the breast tissue and
31:22axillary lymph nodes. We're inspecting
31:25for enlargement, skin changes, nipple
31:27discharge, masses. We're palpating
31:29beneath the nipple and surrounding
31:31tissues for any nodules, firm masses,
31:33tenderness.
31:34And then gynecomastia, this refers to
31:36benign enlargement of male breast
31:38tissue. It may occur during puberty,
31:41aging, obesity, hormonal disorders,
31:44liver disease, or some medications.
31:48Um
31:48So, we're differentiating diffuse
31:50enlargement from a discrete suspicious
31:52mass in that case.
31:56And then additional techniques, we have
31:57bimanual technique. This may be useful
31:59for examining large breasts. So, one
32:02hand is supporting the breast while the
32:03other palpates the tissue between both
32:05hands. Um this technique may help
32:08identify deep masses that are difficult
32:10to um palpate with standard palpation.
32:17And then lastly, we're making clinical
32:19decisions, right? So, after assessment
32:22findings are identified, we're going to
32:24interpret and communicate significance
32:26of any diagnostic testing, including
32:29mammography,
32:31um ultrasound, potentially MRI, or
32:35biopsies.
32:38We're using our clinical judgment. So,
32:40what does the test result mean for this
32:42particular patient um
32:45along with our assessment findings,
32:46their risk factors, and the patient's
32:48concerns. And then we're prioritizing
32:51our hypothesis of what's going on, and
32:53we're taking action. Um so, priority
32:56findings, maybe this is a new breast
32:58mass, maybe they have bloody nipple
32:59discharge or skin dimpling, a new nipple
33:02retraction, um etc. So, we're
33:05determining the next steps. Um are we
33:07notifying the provider? Are we um
33:10potentially thinking additional
33:12diagnostic testing is needed? Are we
33:14providing patient education? Are we
33:17referring to any specialists?
33:19And then we're analyzing changing
33:21findings. Um ongoing assessment is going
33:24to be essential. We're comparing our
33:25current findings with the previous
33:27documentation.
33:29Um we're asking, has the mass changed in
33:32size? Is pain improving or is it
33:34worsening? Have skin changes progressed?
33:36Is the treatment effective?
33:39Um and then maybe we're collaborating
33:43interprofessionally
33:44um with primary care providers or
33:47women's health specialists,
33:49radiologists, surgeons, oncologists,
33:53genetic counseling, um maybe
33:55psychosocial support is necessary, um
33:57because a new breast cancer diagnosis is
34:00definitely going to create anxiety,
34:03fear, maybe financial concerns or
34:05transportation challenges, treatment
34:08barriers. So, you know, gathering all of
34:11all the people we need, maybe social
34:13work and community resources may maybe
34:15involved.
34:17Coming up with a plan of care, um
34:20definitely basing it individually on our
34:23assessment findings and the patient's
34:24needs.
34:26Health promotion. We are always talking
34:30to our patients about breast
34:31self-awareness, education, screening
34:34recommendations, lifestyle
34:35modifications. Um
34:37if they have any acute concerns, what
34:39that might look like.
34:42And we're finally evaluating the
34:45outcomes to determine whether our
34:47interventions were effective or not.
34:55And that is it for today.
34:57I hope you have a wonderful day.
35:00And I'll see you in class.

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