BREAST EXAMINATION
This is from a Medical School Site on How to do this exam
A. Visually examine breasts.
1. Patient sits at end of exam table, health care provider stands in
front of her.
2. Ask the patient to remove gown to her‑waist. Assist only if needed.
3. Have the patient relax arms to her side.
4. Examine visually for following:
Approximate symmetry
Dimpling or retraction of skin
Swelling or discoloration
Orange peel effect on skin
Position of nipple
Discharge
B. Conduct three (3) maneuvers to observe movement of breast tissue.
1. Ask the patient to slowly raise arms above her head.
2. Have the patient shrug her shoulders, then press her palms into hips.
3. Have the patient lean forward (if breast are pendulous).
4. Conclude visual exam with reassuring statement.
"Everything is normal."
A statement provides the patient with information from the
examiner that no problems or abnormalities are present.
Anxiety regarding completed portion of exam is reduced.
c) Patient begins to associate her body
type and structures as being normal.
d) If an obvious abnormality is found, address it briefly. Discuss the
problem in detail in an office setting with the patient after the entire
exam is finished.
C. Palpation of breast tissue, areola and nipple in
recumbent position.
1. Explain procedures and purpose.
2. Ask the patient to regown.
3. Exam table must be in horizontal position.
a) Instruct the patient to move her
legs to one side.
b) Inform her that you will be pulling out exam
table extension for her legs
c) Ask patient to lean back in recumbent position and place hand behind
her head on the side you will
be examining.
d) Place folded drape sheet/pillow under her shoulder on the side you are
examining.
4. Ask patient to remove gown from right breast when
examining right breast, then regown.
Repeat for left breast.
5. Begin to palpate at junction of clavicle and sternum.
If any sores or discharge are visible ‑ glove.
Use the flat pads of the first three fingers, not finger tips.
Press breast tissue against wall in small circular motions at three
levels. Use very light pressure to assess superficial layer, moderate
pressure for middle layer and firm pressure for deep layers.
Overlap circular motions.
e) Palpate breast in vertical strips overlapping
coverage. Continue until you have covered to the auxiliary "tail".
6. Palpate around the areola and the depression under the
nipple.
7. Lower the patient's arms and palpate for auxiliary lymph nodes.
8. Have the patient replace the gown and repeat on other side.
9. Reassure the patient, discuss the results of the breast exam.
D. GOING BEYOND THE BREAST AND PELVIC EXAM
1. Many women may receive the annual Gyn exam as their
only yearly physical exam.
2. Conduct as much of a general physical as possible because many women may
not see another health care provider. When taking an Ob/Gyn history, keep in
mind that the visit may be the only annual exam. Be aware that the patient
may have additional needs and questions beyond the field of Ob/Gyn.
3. Violence against women is of epidemic proportions in this country. If a
woman speaks of trauma or if you observe bruises, it is your responsibility
to continue the conversation. As a health care provider, you should have
resource information to give to your patients.
|