Exam Summary


1. Introduction

Introduce yourself and the examination.

a. Considerations

When introducing the examination consider the following:
  • Body Stance and positioning
  • Facial expression
  • Eye contact (1/3 at patient, 1/3 at breast, 1/3 away is preferable)
  • Dignity of patient
  • Use of language (examine vs feel or look, lower gown vs get undressed)

b. 5 Steps of Consent

  • Explain procedure
  • Check for understanding
  • Ask if there are any questions
  • Mention STOP signal
  • Ask to proceed

c. Wash Hands

2. Inspection

  • Ask patient to lower gown
  • Look for
    • Symmetry
    • Lumps
    • Skin changes
    • Rashes/ Redness
    • Ulcers
    • Nipple Discharge
    • Retracted Nipples
  • Ask the patient to raise arms above their head to assess tissue movement.
  • Ask the patient to place their hands on their hips and lean forwards to assess tissue movement.
  • Remember to look underneath large breasts

3. Palpation

  • Use flat fingers with a circular motion
  • Ask the patient to raise their arms above their head
  • Start with light pressure making a circle
  • Slide with deeper pressure to the next area
  • Move up and down the breast in strips
  • Only use medium pressure over the nipple because it is more tender

4. Lymph Nodes

  • Palpate Supraclavicular lymph nodes
  • Palpate Axillary Lymph nodes
    • Behind anterior axillary fold
    • In front of posterior axillary fold
    • Corresponding positions on the upper part of the arm
    • Move the patient's arm down to her side and feel deep into the top of the axilla.

5. Conclude

Thank patient and allow privacy or offer assistance if needed.

See Also

Breast Cancer

Reference

Principles of Clinical Practice - Clinical Examinations Guide 2015 pp128-129