GU/SEXUAL/BREAST

Clinical Breast Exam:

Pads of three fingers (not the tips)

Three different pressures – light, medium, deep

Axillary nodes one of the first places breast cancer is noticed

CBE – Clinical Breast Examination

Health History

Inspection

Node Examination

Palpate

Plan of action

Documentation

Inspect – Different Positions

Arms at Side

Arms over head

Arms on Hips (pushing down)

Bend forward

Position the Patient (Cahan Position)

Roll on hip (fetal position) – roll shoulder back – hand on forehead

Should do CBE in this position (lying down – Cahan position)

Mammograms 3 months after CBE

CBE best the week after period ends

Lump – when you can feel, there 5 years (more then likely)

Oatmeal – lumpy normally, if you feel raison then problem

If find a Lump:

Over 35 send for Mammogram

Under 35 send for Ultrasound

Exam the Mastectomy Site (Important – 1% chance of recurrence)

Mostly at site

Lumpectomy – Breast feels firmer

If Clinical +, and Mammogram –, then follow-up test required (needle biopsy, ultrasound)

Cancer Stages (Breast Cancer):

0 Insitu (None Invasive)

1 <2 cm No Lymph

2 <2 cm Lymph or 3-5 cm no lymph

3 >5 cm

4 Mets

Female Gynecological Exam

Glove – (sometimes double glove)

External Exam

Palpate Inguinal Lymph Nodes (horizontal & Vertical)

Inspect Mons Publis – Skin, lesions, and infestations

Inspect Clitoris & the hood of the clitoris

I&P Labia Majora

I&P Labia Minora

I&P External Genitalia

Introitus (check for tone)

Urethra

Opening of the Skenes glands

Opening of the Bartholins gland

(8 & 4 oclock)

Inspect the perineum

Perianal area and anus

Speculum Exam:

Inspect Speculum (size depends on age, parity, vaginal tone and body habitus)

Inspect the Vaginal Walls (rugae), Cervix (or cuff), and take any tests

Bimanual Exam (hand outside – hand in)

Palpate for cervical motion tenderness

Palpate the uterus for position, size, shape & consistency

Size – Pear

Consistency – should be just right (not too hard, not too soft)

Should be able to feel ovaries

Palpate the adnexa for masses

Palpate the vaginal walls

Check for cystocele (Bladder bulge-from child birth and age) and rectocele (rectal bulge)

Rectal exam as needed (all women over 40 or if unable to palpate the uterus)

Test for FOB (fecal occult blood) as needed.