The document provides guidance on examining a patient's breasts and axillae. It describes the anatomy and outlines the procedure which involves inspection and palpation. Inspection involves examining the breasts visually for signs of abnormalities while palpation involves thoroughly feeling the breasts using a systematic approach to identify any masses or irregularities. Any findings should be carefully documented including location, size, shape, consistency and characteristics. The exam also includes inspecting and palpating the axillae and nipple areas.
In obstetrics, Leopold maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight.
The aim of Leopold maneuvers is to determine the fetal presentation and position by systematically palpating the gravid abdomen.
ctto Marie Belen Tamayor - Leopold's Maneuver, Miss Marie's presentation provided the slides that explain Leopold's maneuver.
format of case study : a Nursing point of view. it includes all the headings or points about which the information regarding the patient needs to be collected and helps to write a detailed case study
In obstetrics, Leopold maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight.
The aim of Leopold maneuvers is to determine the fetal presentation and position by systematically palpating the gravid abdomen.
ctto Marie Belen Tamayor - Leopold's Maneuver, Miss Marie's presentation provided the slides that explain Leopold's maneuver.
format of case study : a Nursing point of view. it includes all the headings or points about which the information regarding the patient needs to be collected and helps to write a detailed case study
USMLE ENDOCRINE 04 Mammary glands breast ANATOMY MEDICAL .pdfAHMED ASHOUR
Surgery plays a crucial role in the management of various breast conditions, including both benign and malignant disorders. Understanding the surgical options for breast conditions is essential for breast surgeons, oncologists, and other healthcare professionals involved in breast care.
The choice of surgery depends on the specific diagnosis, patient preferences, and the overall treatment plan.
Surgical interventions aim to address the underlying condition, restore aesthetics when relevant, and contribute to the overall well-being of individuals with breast-related health concerns.
Etiology of the most common breast masses, Triple assessment approach And management of the common causes of the breast masses. Brief intro on anatomy and physiology of the breast.
Breast Cancer Awareness Conversation Starters Series by iStudentNurseiStudentNurse.com
The 'Conversation Starters' is a series by iStudentNurse designed to promote discussions about life-saving awareness topics. Composed by a team of RNs, it draws upon the latest evidence-based research to provide a summary of the most crucial breast cancer awareness concepts. While designed as a lecture outline for nursing students, the Breast Cancer Awareness presentation is also of value to patients, survivors, and healthcare professionals. Topics addressed include: pathophysiology, etiology, epidemiology, risk factors, genetic testing/counseling, the 3 Tiers of Early Detection, screening and diagnostic methods, and treatment modalities (surgery, chemo, radiation, and endocrine therapy). The self-breast exam (SBE) is described step-by-step. Additionally, an example nursing care plan for a post-operative mastectomy is provided, which describes nursing diagnoses, interventions, and outcomes. Happy Student Nursing!
Position patient supine, with the hand on the side you're examining behind their head.
Palpate the asymptomatic breast first.
Palpate using the flat palmar surface of your fingers.
Palpate using a systematic technique to ensure you examine all of the breast regions.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
5. The female breast lies against the anterior thoracic wall, extending from the clavicle and 2nd rib down to the 6th rib, and from the sternum across to the midaxillary line. Its surface area is generally rectangular rather than round. The breast overlies the pectoralis major and at its inferior margin, the serratus anterior.
6.
7. Describe clinical findings, the breast is often divided into four quadrants based on horizontal and vertical lines crossing at the nipple.
8. An axillary tail of breast tissue extends toward the anterior axillary fold. Alternatively localized as the time on the face of a clock and the distance in centimeters from the nipple.
12. Lymphatics from most of the breast drain toward the axilla. Central nodes are palpable most frequently. They lie along the chest wall, usually high in the axilla and midway between the anterior and posterior axillary folds.
13.
14. Pectoral nodes Anterior, located along the lower border of the pectoralismajor inside the anterior axillary fold. These nodes drain the anterior chest wall and much of the breast.
15. Subscapularnodes Posterior, located along the lateral border of the scapula; palpated deep in the posterior axillary fold. They drain the posterior chest wall and a portion of the arm.
18. Common or Concerning Symptoms Breast lump or mass Lumps may be physiologic or pathologic, ranging from cysts and fibroadenomas to breast cancer. Breast pain or discomfort Nipple discharge Milky bilateral discharge, or galactorrhea, may reflect pregnancy or prolactin or other hormonal imbalance. Non milky unilateral discharge suggests local breast disease.
19.
20. Risk Factors for Breast Cancer Breast cancer - most common cause of cancer in women worldwide, accounting for 18% of all female malignancies. >12% - lifetime risk of developing breast cancer Approximately 22% - risk of dying from the disease 70% - no known predisposing factors definite risk factors are well-established
21. Risk Factors for Breast Cancer Age Family History Relative risk of breast cancer menstrual history pregnancy breast conditions and diseases Risk from familial breast cancer family history of breast cancer genetic predisposition
22. Risk Factors for Breast Cancer Menstrual History and Pregnancy Early menarche Delayed menopause First live birth after age 35 or no pregnancy all raise the risk of breast cancer two- to three-fold.
23. Risk Factors for Breast Cancer Breast Conditions and Diseases Benign breast disease with biopsy findings Atypical hyperplasia Lobular carcinoma Breast Cancer Screening Breast self-examination method
25. Recording the Physical Examination Breasts and Axillae “Breasts symmetric and without masses. Nipples without discharge.”
26. Recording the Physical Examination Breasts and Axillae “Breasts pendulous with diffuse fibrocystic changes. Single firm 1 × 1 cm mass, mobile and nontender, with overlying peaud’orange appearance in right breast, upper outer quadrant at 11 o’clock.”
30. Inspect the breasts and nipples with the patient in the sitting position and disrobed to the waist.
31. Arms at Sides Appearance of the skin Color Thickening of the skin and unusually prominent pores, which may accompany lymphatic obstruction Redness from local infection or inflammatory carcinoma Thickening and prominent pores suggest a breast cancer.
35. Arms at Sides Contour of the breasts Look for changes such as masses, dimpling, or flattening. Compare one side with the other Flattening of the normally convex breast suggests cancer.
36. Arms at Sides Characteristics of the nipples, size and shape, direction in which they point, any rashes or ulceration, or any discharge Asymmetry of directions in which nipples point suggests an underlying cancer. Rash or ulceration in Paget’s disease of the breast
38. Recent or fixed flattening or depression of the nipple suggests nipple retraction. A retracted nipple may also be broadened and thickened.
39. Inverted nipple Nipple in inverted, or depressed below the areolar surface. Long-standing inversion - a normal variant of no clinical consequence, except for possible difficulty when breast-feeding.
42. To bring out dimpling or retraction that may otherwise be invisible Ask the patient to raise her arms over her head, then press her hands against her hips to contract the pectoral muscles. Inspect the breast contours carefully in each position. If the breasts are large or pendulous, it may be useful to have the patient stand and lean forward, supported by the back of the chair or the examiner’s hands.
44. Dimpling or retraction of the breasts When a cancer or its associated fibrous strands are attached to both the skin and the fascia overlying the pectoral muscles, pectoral contraction can draw the skin inward, causing dimpling.
49. Leaning Forward Reveal an asymmetry of the breast or nipple not otherwise visible. Retraction of the nipple and areola suggests an underlying cancer.
51. BS3 MNEUMONIC Best performed when the breast tissue is flattened. Supine position 3 minutes thorough examination for each breast. Use the fingerpadsof the 2nd, 3rd, and 4th fingers, keeping the fingers slightly flexed.
52. Palpation Systematic Vertical strip pattern - the best validated technique for detecting breast masses. Apply light, medium, and deep pressure. You will need to press more firmly to reach the deeper tissues of a large breast. Your examination should cover the entire breast, including the periphery, tail, and axilla.
53. To examine the lateral portion of the breast Ask the patient to roll onto the opposite hip, placing her hand on her forehead but keeping the shoulders pressed against the bed or examining table.
54.
55. Begin palpation in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple, then reposition the patient to flatten the medial portion of the breast. Nodules in the tail of the breast are sometimes mistaken for enlarged axillary lymph nodes (and vice versa).
56.
57. To examine the medial portion of the breast, Ask the patient to lie with her shoulders flat against the bed or examining table, placing her hand at her neck and lifting up her elbow until it is even with her shoulder. Palpate in a straight line down from the nipple to the bra line, then back to the clavicle, continuing in vertical overlapping strips to the midsternum.
58. Examine the breast tissue carefully for: Consistency of the tissues. Normal consistency varies widely, depending in part on the relative proportions of firmer glandular tissue and soft fat. Physiologic nodularity may be present, increasing before menses.
59. Examine the breast tissue carefully for: There may be a firm transverse ridge of compressed tissue along the lower margin of the breast, especially in large breasts. This is the normal inframammary ridge, not a tumor. Tender cords suggest mammary duct ectasia, a benign but sometimes painful condition of dilated ducts with surrounding inflammation, sometimes with associated masses.
60. Mammary Duct Ectasia Benign Painful condition of dilated ducts with surrounding inflammation, sometimes with associated masses.
61. Examine the breast tissue carefully for: Tenderness Premenstrual fullness Nodules Palpate carefully for any lump or mass that is qualitatively different from or larger than the rest of the breast tissue.
62. Hard, irregular, poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest cancer. Location— quadrant or clock, with centimeters from the nipple Size— centimeters Shape— round or cystic, disclike, or irregular in contour Consistency— soft, firm, or hard Assess and describe the characteristics of any nodule:
63. Assess and describe the characteristics of any nodule: Delimitation— well circumscribed or not Tenderness Mobility— in relation to the skin, pectoral fascia, and chest wall. Gently move the breast near the mass and watch for dimpling. Cysts, inflamed areas, some cancers may be tender
64. The Nipple Palpate each nipple, noting its elasticity. Thickening of the nipple and loss of elasticity suggest an underlying cancer.
66. The Male Breast Inspect the nipple and areola for nodules, swelling, or ulceration. Palpate the areola and breast tissue for nodules. If the breast appears enlarged, distinguish between the soft fatty enlargement of obesity and the firm disc of glandular enlargement, called gynecomastia. Gynecomastia - imbalance of estrogens & androgens, sometimes drug-related. Breast cancer - A hard, irregular, eccentric, or ulcerating nodule.
69. INSPECTION Inspect the skin of each axilla Rash Infection Unusual pigmentation Deodorant and other rashes Sweat gland infection (hidradenitissuppurativa) Deeply pigmented, velvety axillary skin suggests acanthosisnigricans, one form of which is associated with internal malignancy.
70. PALPATION To examine the left axilla Ask the patient to relax with the left arm down. Help by supporting the left wrist or hand with your left hand. Cup together the fingers of your right hand and reach as high as you can toward the apex of the axilla. Warn the patient that this may feel uncomfortable.
71. PALPATION Your fingers should lie directly behind the pectoral muscles, pointing toward the midclavicle. Now press your fingers in toward the chest wall and slide them downward, trying to feel the central nodes against the chest wall. Of the axillary nodes, these are the most often palpable. One or more soft, small (<1 cm), nontendernodesare frequently felt.
72. PALPATION: ABNORMALITIES Enlarged axillary nodes from infection of the hand or arm, recent immunizations or skin tests in the arm, or part of a generalized lymphadenopathy. Check the epitrochlear nodes and other groups of lymph nodes. Nodes that are large (≥1 cm) andfirm or hard, matted together, or fixed to the skin or to underlying tissues suggest malignant involvement.
78. History of spontaneous nipple discharge Determine its origin by compressing the areola with your index finger, placed in radial positions around the nipple. Watch for discharge appearing through one of the duct openings on the nipple’s surface. Note the color, consistency, and quantity of any discharge and the exact location where it appears.
79.
80. Papilloma Nonmilky unilateral discharge - local breast disease. Causative lesion – benign Malignant - elderly women Note the drop of blood exuding from a duct opening.
82. Examination of The Mastectomy Patient Warrants special care on examination. Inspect the mastectomy scar and axilla carefully for any masses or unusual nodularity. Note any change in color or signs of inflammation. Palpate gently along the scar—these tissues may be unusually sensitive. Use a circular motion with two or three fingers.
83. Examination of The Mastectomy Patient Upper outer quadrant and axilla. Note any enlargement of the lymph nodes or signs of inflammation or infection. Lymphedemamay be present in the axilla and upper arm from impaired lymph drainage after surgery.
84. Examination of The Mastectomy Patient Masses Nodularity Change in color or inflammation
93. Teach the patient how to perform the breast self-examination (BSE). A high proportion of breast masses are detected by women examining their own breasts. Inexpensive and may promote stronger health awareness and more active self-care.
94. Early detection of breast cancer BSE is most useful when coupled with regular breast examination by an experienced clinician and mammography. BSE is best timed just after menses, when hormonal stimulation of breast tissue is low.
95. Lie down with a pillow under your right shoulder. Place your right arm behind your head. Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. The finger pads are the top third of each finger.
96. Press firmly on the breast in an up-and-down or “strip” pattern. You can also use a circular or wedge pattern, but be sure to use the same pattern every time. Check the entire breast area, and remember how your breast feels from month to month.
97. Repeat the examination on your left breast, using the finger pads of the right hand. If you find any changes, see your doctor right away.
98. Press firmly enough to know how your breast feels. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your health care provider, or try to copy the way the doctor or nurse does it.
99. Repeat the examination of both breasts while standing, with one arm behind your head. The upright position makes it easier to check the upper outer part of the breasts (toward your armpit). This is where about half of breast cancers are found.
100. You may want to do the upright part of the BSE while you are in the shower. Your soapy hands will make it easy to check how your breasts feel as they glide over the wet skin.
101. For added safety, you might want to check your breasts by standing in front of a mirror right after your BSE each month.
102. See if there are any changes in the way your breasts look, such as dimpling of the skin, changes in the nipple, redness, or swelling. If you find any changes, see your doctor right away.
104. Performance Evaluation Checklist Inspect breasts for size, symmetry & contour or shape. Using a good source of light, carefully inspect the breasts while the client is in sitting position.
105. Performance Evaluation Checklist Inspect the skin of the breast for localized discolorations or hyperpigmentation, retraction or dimpling, localized hypervascular areas, swelling or edema. Emphasize any retraction by having the client: Raise the arms above the head Push the hands together, with elbows flexed.
106. Performance Evaluation Checklist Inspect the areola area for size, shape, symmetry, color, surface characteristics & any masses or lesions.
108. Performance Evaluation Checklist Palpate the axillary, subclavicular lymph nodes. The client is seated with the arms abducted and supported on the nurse’s forearm. Use the flat surface of all fingertips to palpate these areas.
109. Performance Evaluation Checklist Palpate the breast for masses, tenderness and any discharge from the nipples. Enhance flattening of the breast, instruct client to abduct arm & place her hand behind her head. Then, place a small pillow or rolled towel under the client’s shoulder.
110. Performance Evaluation Checklist Palpate the breast for masses, tenderness and any discharge from the nipples. Use palmar surface of the middle 3 fingertips held together & make gentle circular motion on the breast.
Pectoral nodes—anterior, located along the lower border of the pectoralismajor inside the anterior axillary fold. These nodes drain the anterior chest wall and much of the breast.Subscapular nodes—posterior, located along the lateral border of thescapula; palpated deep in the posterior axillary fold. They drain the posterior chest wall and a portion of the arm.Lateral nodes—located along the upper humerus. They drain most of the arm.Lymph drains from the central axillary nodes to the infraclavicular andsupraclavicular nodes.Not all the lymphatics of the breast drain into the axilla. Malignant cells from a breast cancer may spread directly to the infraclavicular nodes or into deep channels within the chest.
The relative risk (or risk relative to an individual without a given risk factor)First-degree relatives, namely a mother or sister with breast cancer, establish a “positive family history.” Within this group, menopausal status and extent of disease play a key role. Having firstdegreerelatives with breast cancer who are premenopausal with bilateral diseaseconfers the highest risk. Even when a mother and a sister have bilateralbreast cancer, however, the probability of breast cancer is only 25%.-
Note that initially you may use sentences to describe your findings; later you will use phrases. The style below contains phrases appropriate for most write-ups. Unfamiliar terms are explained in the next section, Techniques of Examination.“Breasts symmetric and without masses. Nipples without discharge.” (Axillaryadenopathy usually included after Neck in section on LymphNodes,
Some difference in the size of the breasts,including the areolae, is common and is usually normal
Uncommon type of breast cancer Mammary Paget’s Disease
A retracted nipple may also be broadened and thickened – underlying CANCER
Occasionally, these signs may be associated with benign lesionssuch as posttraumatic fat necrosis or mammary duct ectasia, but theymust always be evaluated with great care.
When pressing deeply on thebreast, you may mistake a normalrib for a hard breast mass.
This flattens the lateral breast tissue.
NODULES: This is sometimes called a dominant mass and may reflect a pathologic change that requires evaluation by mammogram, aspiration, or biopsy.
If the central nodes feel large, hard, or tender, or if there is a suspicious lesionin the drainage areas for the axillary nodes, feel for the other groups of axillarylymph nodes:Pectoral nodes—grasp the anterior axillary fold between your thumb andfingers, and with your fingers palpate inside the border of the pectoralmuscle.Lateral nodes—from high in the axilla, feel along the upper humerus.Subscapular nodes—step behind the patient and with your fingers feel insidethe muscle of the posterior axillary fold.Also, feel for infraclavicular nodes and reexamine the supraclavicular nodes.