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Breast Axillae and Lymphatics
  • Accessory reproductive organs
  • Glandular tissue contains 15-20 lobes
  • Suspensory ligaments: Cooper's ligament (runs vertically up the chest wall to support the breast)
  • Adipose tissue provides most of the bulk of the breast
  • The breasts have extensive lympatic drainage
Subjective data for breast
  • pain
  • lumps
  • discharge
  • rash (can be cause by inflammatory breast CA)
  • swelling
  • trauma (trauma superior to the breast can run down into the breast drainage, etc)
  • surgery
  • breast disease
  • lymphedema can cause peau d'orange
Subjective data for axilla
  • tenderness
  • lumps
  • swelling
  • rash
Assessment of breast health
  • obtain breast health history
  • BSE? (4-7 days after menses, monthly)
  • pain in one or both breasts including relationship to mentrual period
  • history of lumps, swelling, redness, change in size, or dimpling
  • history of discharge from brasts
  • inflammation could be a sign of an infection
  • Familial history of breast CA (sister, mother, grandmother is significant)
  • history of breast disease
  • Menstrual irregularities (long lifetime menstrual cycle increases risk)
  • use of hormones, antidepressants, oral contraceptives (can increase risk of certain CAs)
  • enviromental exposure to benzene or asbestos
Breast abnormalities
  • Breast CA common in tail of spence
  • peau d'orange from edema
Breast mass characteristics
  • location
  • size in cm
  • shape: lobule, round, oval
  • consistency: soft (often cystic), firm (worse that soft)
  • movable: fixed is worse
  • nipple: check for inversion
  • tenderness
Male reproductive anatomy
  • Urethra: transverses the penis and its meatus, forms a slit at the glans
  • scrotum: a loose sac which is a continuum of the abd wall
  • the testis are capped by the epididymis which is a coiled duct system that stores sperm
Male reproductive subjective data
  • Frequency, urgency, and nocturia
  • dysuria
  • hesitancy and straining (BPH)
  • GU history
  • Urine color (cloudy or hematuria)
  • penis (pain or discharge)
  • scrotal pain or masses (can transilluminate)
  • self care behaviors (monthly exam)
  • sexual activity and contraceptive use
  • Hx of STDs or ED
  • UTIs (need to be worked up, 1:25 M:F)
Male reproductive disorders
  • Testicular Torsion: twisted spermatic cord, sudden onset, N/V, aferbile, more common in early childhood and adolescence, rare after 20 y/o
  • Epididymitis: sudden onset, scrotal swelling, N/V, fever, can be caused by gonohrrea or chlamydia, elevation relieves pain
  • Testicular CA: painless lump, common 18-35, almost all are malignant
  • scrotal hernia: soft mushy protrusion into scrotum
  • undescended testes increase risk of future testicular CA
Why are testicular and ovarian CAs often more deadly.
Neither organ is covered by an omentum allowing the CA to seed the body.
Female reproductive health history
  • Menstrual history
  • STD history
  • use of contraceptives
  • frequency of pelvic exams
  • annual pap smears
  • Hx of discharge, itching, pain on urination
  • Hx of smoking
  • Familial history of reproductive CA
Male reproductive health history
  • History of STDs
  • Hx of undescended testes
  • Hx of UTI
  • self care behaviors (monthy self exam)
  • use of contraceptives (latex allergies)
  • Hx of discharge, itching, pain on urination
Assessment of reproductive organs
  • Inspect and palpate
  • the bladder should be empty
  • inspect external genitailia for lesions and discharge
  • males should be standingfemales with legs in stirrups
Abdomen: general info
  • Inside the abd cavity all the internal organs are the viscera
  • solid viscera maintain characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys)
  • Hollow viscera: stomach, gallbladder, small intestine, colon, bladder
  • divided into four quadrants bisecting at the umbilicus
Abd subjective assessment
  • Appetie: changes? for how long?
  • Weight loss/gain over what period
  • Dysphagia: describe it
  • OTC meds
  • Food intolerances and allergies
  • smoking hx (erodes mucosal lining and increases risk of ulcers
  • Abd pain (PQRST)
  • N/V
  • Bowel habits and routines
  • Past history (peptic ulcer disease, etc)
  • Female menstrual history (abd pain ectopic until r/o)
  • Black tarry stool= upper GI bleed
Abd pain
  • Heart burn/GERD
  • N/V, fever, chills, other associated symptoms
  • Liver disease: hep A-E
  • Urinary tract disorders: frequency, color, nocturia, polyuria, urgency, incontinence
Subjective abd assessment for infants and children
  • breast or bottle feeding (mom's intake can affect child)
  • What foods have been introduced
  • how often does your child eat
  • does your child have constipation? megacolon?
  • does your child have abd pain
  • Is the child overweight? for how long?
Objective abd assessment
  • auscultate bowel sounds and vascular sounds (high pitched)
  • bowel sounds can be hyperactive or hypoactive
  • vascular sounds: listen for bruits, it is not normal to hear any vascular sounds
  • Inspect abd and assess contour (flat, round, scaphoid, protuberant)
  • assess symmetry, umbilicus should be at the midline, skin color and presence of striae
Objective abd assessment cont.
  • percuss general tympany, liver span (10.5-11 cm, splenic dullness)
  • dullness over a distended bladder, flud, or mass
  • hyperresonance over gastric bubble
  • splenic dullness: 9th to 11th rib just behind the midaxillary line
Objective abd assessment
  • palpate surface and deep areas
  • bend the pt's knnes and tell them to breathe slowly
  • light to deep palpation with the first four fingers close together
  • depress the skin 1 cm in a circular motion palpating for firmness, deep palpation is 5-8 cm
  • tender areas are palpated last
Objective abd assessment
  • percusion of costrovertebral tenderness 12th rib "thud"
  • kidney infection=flank pain
  • assess for a fluid wave (ascities free fluid in peritoneal cavity)
Assessing rebound tenderness
  • Blumberg's sign: hold hand at 90 deg and push down firmly, release quickly. Pain on release is a sign of peritoneal irrigation
  • Murphy's sign: deep breath, hold fingers under the liver border, ask them to breathe deep sharp pain midway through inspiration
Abdominal signs
  • Grey-Turner's sign: flank bruising, takes 24-48 hours. It can predict a severe case of acute pancreatitis
  • Cullen's sign:  superficial edema and bruising in the sq fatty tisse around the umbilicus, possible ruptured ectopic, abd trauma,
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