Transcript Examination of Male & Female Genitalia, Breast

Examination of Male & Female
Genitalia, Breast, Prostate &
Rectum
Janet M. Galiczewski
RN, CCRN, MSN, ANP
Breast A& P
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Breast overlies pectoralis major.
Breast is a hormonally sensitive tissue.
Upper Outer Quadrant-site of most breast cancers.
Breast composed of glandular tissue, fibrous tissue
including suspensory ligaments, adipose tissue.
Proportion varies with age, cycle, pregnancy,
lactation, & general nutrition.
Suspensory ligaments (Cooper’s Ligaments)
support breast tissue, contract in CA breastproduce pits or dimples in overlying skin.
Breast Lymphatics
Central
 Pectoral (Anterior)
 Subscapular (Posterior)
 Lateral
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Breast Cancer Risk Factors
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Family History
Menstrual History
Pregnancy
Age
Sex
Education & Income
Location
Caucasian Women
A Good History is
imperative
Techniques of Breast Exam.
Inspection:
 Pt sitting, disrobed to the waist,arms at
sides.
 Inspect breasts, note appearance of skin;
color, redness from infection or
inflammatory CA.
 Size & symmetry of breasts
 Contour
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Technique of Breast Exam.
Inspect nipples; note size & shape, direction
in which they point, rashes or ulceration,
discharge.
 Assess breast development according to
Tanner.
 Check for dimpling or retraction.
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Exam (Cont).
Palpation:
 Ask pt. to lie down
 Bring pts arm overhead, use pads of first
three fingers, compress tissue gently.
 Use a pattern: concentric circles (or other
method).
 Note: Consistency of tissues, tenderness,
nodules.
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If you find a nodule:
Location
Size
Shape
Consistency
Movable
Distinctness
Nipple
Lymphadenopathy
Exam (cont)
Palpate each nipple.
 Compress the areola with your index finger
& thumb, watch for discharge.
 Male Breast: Monthly exam (self), clinical
exam every 1-3 years.
 Inspect nipple & areola for nodules,
swelling, ulceration.
 Palpate the areola for nodules.
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Breast Cancer Screening
Encourage bilateral self - breast exams
monthly. 5-7 days after onset of menses.
They should continue after menopause.
 Age 20-39 CBE every three years.
 =/> 40 CBE yearly along with
mammography.
 For women at increased risk mammography
should be initiated at 30 years of age.
 After 70 the benefits of mammography is
less well defined.
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Save a Life
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Cumulative lifetime
risk factor for
developing BREAST
CANCER is :
1
in 7
Choose to be
proactive!!
 Choose to Live!!
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Female Genitalia A&P
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Labia Majora
Labia Minora
Vestibule
Introitus
Perineum
Urethral Meatus
Skene’s Glands
Bartholin’s Glands
Female Genitalia (Internal)
Vagina
 Uterus
 Cervix
 External Os
 Fallopian Tubes
 Ovaries; Adnexa
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Internal Female Genitalia
Examination
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Empty Bladder
Position & Drape Appropriately
Inspect external genitalia; separate labia majora &
inspect
 Labia minora
 Clitoris
 Urethral meatus
 Introitus
 Note:inflamm.,ulceration,
discharge,swelling,nodules,palpate any lesions.
If you suspect urethritis or inflammation of
the paraurethral glands (Skene’s): Insert
index finger into vagina, milk urethra gently
from inside outward.
 May be R/T chlamydia or gonorrhea, get
culture.
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Internal Exam.
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Locate the cervix
Assess support of the vaginal wall
 Cystocele
 Uterine Prolapse
 Rectocele
Insert Speculum
Inspect Cervix & Os
Pap Smear
Exam (cont).
Perform a Bimanual exam.
 Palpate the cervix
 Palpate the uterus
 Retroversion of the uterus
 Palpate Each Ovary
 Rectovaginal Exam
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Male Genitalia A & P
Shaft of the penis
 Glans
 Prepuce/foreskin
 Urethra
 Urethral meatus
 Scrotum
 Testes
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Male Genitalia
Inguinal canal
 External Inguinal ring
 Inguinal Hernias
 Femoral Hernias
 Prostate
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Prostate
Examination of Male Genitalia
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Penis
 Inspection
 Foreskin,smegma, phimosis, paraphimosis.
 Glans; hypospadias
 Palaption palpate shaft between thumb & 1st 2
fingers; feel for induration along ventral
surface.
Scrotum
 Inspection
 Palpation
Testicular Cancer (See Handout)
Examination of Male Genitalia
Transillumination of the scrotum
 Hydrocele
 Hernias: Inguinal & Femoral
 Inspection
 Palpation
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Prostate Examination
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Note:
Size:2.5cm x 4 cm wide
Shape:heart with palpable central groove
Consistency: elastic, rubbery
Nodules
Tenderness: nontender to palpation
Mobility: slightly mobile
Should not protrude more than 1 cm into rectum
Anus & Rectum
Anal canal surrounded by 2 layers of
muscle called sphincters
 Internal sphincter is under involuntary
control.
 External sphincter is under voluntary
control.
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Examination of the Anus &
Rectum
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Inspect saccrococcygeal & perianal areas for:
Lumps
Ulcers
Inflammation
Rashes
Excoriation
Hemorrhoids
Venereal warts
Herpes
Hemorrhoid
Examination of the Anus &
Rectum
Examine sphincter tone of the anus; Note:
 Tenderness
 Induration
 Irregularities
 Insert finger clockwise & counterclockwise
 Note; nodules, irregularities, induration
 Stool for occult blood (Guiac)
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