NCM 112 – Skills Lab

PERFORMING BREAST EXAMINATION

BREAST EXAMINATION
 An inspection or investigation of the breast as a
means of diagnosing abnormalities or disease.

RATIONALE
1. To detect abnormalities in the breast
2. To teach client how to perform breast self-
examination

6. Palpate the adjacent lymph nodes

 Supraclavicular
 Infraclavicular
 Subclavian

EQUIPMENTS:
 Chair
 Bed
 Rolled towel
 Small pillow 7. Palpate breasts using pads of the palmar surfaces
 Drape of the fingertips. Palpate the right breast gently
compressing the mammary tissues against the
PLANNING AND IMPLEMENTATION chest wall.
1. Review personal hx & family health hx.
2. Ask the client to disrobe
3. Wash hands
4. Client to a sitting position facing you and expose
chest or breast.
5. Inspect the:
 Breast
 Areola
 Nipples

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8. Teach breast examination as you examine. 15. Allow client to dress.
During the part of the exam, place the client’s 16. Remove gloves and wash hands
fingers under the practitioner’s fingers. 17. Give the client written materials to reinforce
9. Palpate areola and nipple by using similar teaching. Instruct the client when to schedule the
circular technique as with breast. Gently press next clinical examination.
the nipple between the fingers.
EVALUATION AND DOCUMENTATION
1. Client is able to perform monthly breast
examination
2. Client returns for clinical breast examination at
prescribed time.
3. Any abnormalities are identified early for
referral evaluation and possible treatment.
4. Record the date and time.
5. Document findings of abnormalities and absence
of abnormalities.
6. Record the client’s response to findings and
10. Palpate into the axilla: teachings.
7. Record a follow- up plan if necessary.
Anterior axillary line
TEACHING THE CLIENT BREAST SELF-
Mid-axillary line EXAMINATION

Up to the axilla circular fingertip motion

Have client place arm at the side.

SPECIAL CONSIDERATIONS:
 All women 20 years of age and older need
monthly self-breast examination even after
menopause.
 Cancer of the breast is one of the leading causes
11. Repeat actions 7-9 on the left breast, nipple and of death among women
axilla.  Breast self- examination is ideally done one
12. Assist patient to supine position week following menstruation.
 Proper explanation to the client of the
Place arm under head importance of this procedure must be done
 Client’s must be instructed to promptly report
Place small pillow under the same side. any changes noted to the health care provider.
13. Palpate breast, areola and nipple as in actions 7-
10
14. Assist the client to a sitting position. Review the
steps and ask the client to return demonstrate
breast self examination.

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IMPLEMENTATION

Inspection Before A Mirror  Optional: DO the upright BSE in the shower.

 Look for any change in the size or shape; lumps Soapy hands glide more easily over wet skin.
or thickenings; any rashes or other skin
irritations; dimpled or puckered skin; any EVALUATION AND DOCUMENTATION
discharge or change in the nipples (e.g., postion  Client’s Performance
or asymmetry).
 Significant findings, as claimed by the client
 Inspect the breasts in all of the following
positions:
A. Stand & face the mirror with your arm
relaxed at your sides or hands resting on the
hips; then turn to the right and left for a side
view ( look for any flattening in the side
view).
B. bend forward from the waist with arms
raised over the head.
C. Stand straight with the arms raised over the
head and move the arms slowly up and
down at the sides ( look for free movement
of the breast over the chest wall.)
D. press your hands firmly together at chin
level while the elbows are raised to the
shoulder level

PALPATION:

Lying Position
1. Place a pillow under your right shoulder and
place the right hand behind your head.This po
sition distributed breast tissue more evenly on
the chest.
2. Use the finger pads of the three middle fingers (
held together) on your left hand to feel for
lumps.
3. Press the breast tissue against the chest wall
ASSISTING IN PROSTATE GLAND
firmly enough to know how your beast feels. A
EXAMINATION
ridge of firm tissue in the lower curve of each
breast is normal. DEFINITION
4. use small circular motions systematically all the  A prostate exam is a physical examination of the
way around the breast as many times as prostate gland of a male. The prostate gland is a
necessary until the entire breast is covered. gland that surrounds the duct that connects the
5. bring your arm down to your side and feel under male genitals to the bladder. The main function
your armpit, where breast tissue is also located. of the gland is to produce and store seminal
6. repeat the examination on your left breast, using fluid, which is why it is found only in males.
the finger pads of your right hand. The gland is prone to various cancers thus
attempts to detect those condition.
Standing or Sitting
 Repeat the examination of both breasts while
RATIONALE
upright with one arm behind your head.  To examine rectum for abnormalities e.g.
neoplasm, hemorrhoids, polyps and fecal
 This position makes it easier to check the area impaction.
where a large percentage of breast cancer are  To aid in diagnosis of acute appendicitis,
found, the upper outer part of the breast and enlarged prostate and pelvic disorders
toward the armpit.

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EQUIPMENTS the glans gently end of its penis. There is
 Disposable gloves between your normally no discharge. If
 Lubricant Protective sheet index finger discharges is present
 Tissue paper/gauze above and thumb obtrain a culture for
 Torch light below. Note this gonorrhea and chlamydia.
 Protoscope, forceps e.g sponge holding forceps location of the
probe (optional) urethral meatus
 Specimen container as well as any
 Clinical waste discharges,
ulcers, scars,
 Domestic water
nodules, or signs
of inflammation.
PLANNING AND IMPLEMENTATION
8. Palpate the entire To assess for any
length if the tenderness, induration .
ACTION RATIONALE
penis between Palpation of the shaft
1. Ask the client to To provide easy access
your thumb and may be omitted if
disrobe for the exam
first two fingers asymptomatic client.
completely and to
Recliate the foreskin if
put on a gown
restricted, before
2. Explain the To decrease the client’s
continuing with the exam
procedure to the anxiety level
SCROTAL EXAMINATION
client
9. Inspect the To check abnormalities in
3. Wash hands and To perform clean
scrotum for the scrotum as indicative
apply clean technique
erythema, of local trauma,
gloves
discoloration, inflammation, systemic
4. Have the client To provide best exposure
swelling and skin conditions, such as heart
stand and hold up for examination
integrity. or renal failure.
his gown to
10. Extract the To check for the presence
expose the
cremaster relex of the reflex that may be
genitalia
on both sides the most sensitive
5. Inspect the penis To check skin color, note
physical finding for the
and pubic hair size, color, integrity,
scrotum of the testicle. It
distribution. lesions, rash and pustules
is performed by gently
Check the skin at
stroking the superior
the base of the
medical aspect of the
penis for rash,
thigh.
lesions, nuts or
11. Palpate each To evaluate if the left
lice
testis and testicle normally or
6. Retract or have To determine
epididymis slightly lower than the
the client retractuncircumcised male
between the right testicle. The
the prepuce client will have foreskin
thumb and first testicles are apparently
(foreskin) if of the glans which
two fingers. Note and approximately equal
present should be easily retracted
that their size in size. Pressure on the
it is necessary to retract
(high or low testis normally produces
the prepuce to detect
within the a degree of visceral pain.
chance or carcinoma,
scrotum). Shape Twisting or torsion of the
smegma, a cheesy
consistency and testis cause venous
secretion may accumulate
tenderness. The obstruction rarely seen in
normally under the
length of a clients older than 30-35
foreskin
normal testis
7. Observe the glans To take note that the skin should be greater
penis and the of the glans peniis than 4cm and the
urethral meatus. smooth and without volume greater
Open the ulceration. The urethral than 20mL
urethral meatus meatus is eventually
by compressing located verticallyu in the
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 Note: testicular inguinal canal
tension is a surgical and ask the client
emergency. to cough. Note
12. Palpate each To assess for any any herniating
spermatic cord swelling in the scrotum. mass felt against
including the vas Shine a beam of light the finger.
deferens within (flashlight) from behind 16. If the client is To position the client for
the cord between the scrotum through the standing after the ease of examination.
your thumb and mass. Normal testes do completion of the
fingers from the not transilluminate. Look genital
epididymis to the for transmission of light examination,
inguinal ring. and glow. Swellings that have him bend
Note any nodules contain serous fluid and lean on the
or swelling. (hydrocele, spermatocele, exam table with
transilluminate.) legs slightly
HERNIA EXAMINATION apart, exposing
13. Inspect the To assess if there is a the rectum to the
inguinal and bulge that presents on examiner.
femoral areas. strianing suggest hernia. OR
Ask the client to Ask the client to
strain down or lie in lateral
cough while you decubitus
continue your position on his
observation. left side placing
14. To determine presence of his buttocks close
lymph nodes small cm. to the edge of the
firmly mobile lymph table nearest the
nodes may normally be examiner. Flex
found in the inguinal area the client’s hips
RECTAL EXAM and knees to
15. Palpate for an stabilize the
inguinal hernia. client and
Using your right improve
hand for the visibility.
client’s right side 17. Provide warm To decrease the client’s
and your left and quiet anxiety and provides
hand for the environment with privacy. Gentle, slow
client’s left side, appropriate movement of the
just above the lighting, drape examiner’s finger
testicle, the client so that accompanied by
invanginate the only his buttocks explanation and a calm
lose scrotal skin are exposed. demeanor will ensure a
with your index Explain the successful exam
finger. Follow procedure to the
the spermatic client.
cord upward to 18. Wash hands and To prevent spread of
find triangular apply clean microorganisms
slit-like opening gloves
of the external 19. Spread apart the To assess adult perineal
inguinal ring. If buttocks and skin normally more
the inguinal ring examine the pigmented and coarser
is enlarged anus, perineal than the skin over the
enough to admit area and sacral buttocks
your finger, then region for any
gently follow the scars, lesions,

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 nodules, As the client strains fecal material on
inflammations, down, note any tissue your glove and
ulcerations or protrusions or test for occult
abnormalities. hemorrhoids. Reassure blood.
Ask the client to the client that sensations 25. Offer the client To provide client
bear down at you, of urinations and tissue or wipe comfort.
assess for any defecations are normal excess
bulges. lubricant/stool
20. Lubricate the To ease in the insertion, from the anus.
gloved index the anal canal is
finger as the approximately 2.5cm EVALUATION AND DOCUMENTATION
client strains long. It is bordered by the 1. Any abnormalities are identified early for
down, rest the external and internal anal treatment and/or referral.
pad. sphincters, which 2. The client is able to perform monthly testicular
normally are firm and self-examinations
smooth 3. The client returns to his health care provider
21. Insert the finger To assess the wall of the 4. Record the date and time of the examination
as far as possible rectum. It should be 5. Include the client’s physiologic findings of
in the rectum. smooth and moist. abnormalities and absence of abnormalities
Rotate your hand 6. Document instruction and return demonstration
to palpate the of testicular
walls of the 7. Record a follow up plan if necessary.
rectum laterally
and posteriorly ASSISTING IN PELVIC EXAMINATION / PAP
while rotating SMEAR
your index
finger. DEFINITION
22. Anteriorly To inform the client that
palpate the two he may feel the urge to PAPANICOLAU TEST / PAP SMEAR
lobes of the urinate when you  It involves scraping secretions from the cervix.
prostate gland examine the prostate that  Vaginal pool smearing them on the slide, and
and its sulcus. this is a normal sensation immediately coating the slide with fixative
Note the size, and that he will not void. spray or solution to preserve specimen cells for
shape and The male prostate gland nuclear staining.
consistency of is approximately 2.5cm  It also permits cytologic evaluation of the
the prostate as long. It is smooth, non vaginal pool.
you identify any movable, non tender and
irregularities rubbery to the touch. RATIONALE
such as nodules,  To assess the pelvic cavity for the presence of
masses or conditions which include signs of
tenderness. INFLAMMATION, IRRITATION,
23. If possible, To assess for presence of ULCERATION, and INFECTION
extend your swelling. Note for  To evaluate cervicovaginal cells for pathology
finger above the nodules, cysts or that might indicate malignancy
prostate region tenderness
and palpate the Equipment
superior position  vaginal speculum
of the lateral lobe  sterile gloves
to the region of  adjustable lamp
the seminal  cotton applicator
vesicles and the  glass microscope sildes (3)
peritoneal cavity.  biohazard container
24. Gently withdraw To assess for any  cytology fixative
your finger. Note abnormalities.  pap stick(cytology brush)
the color of any  saline solution
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  sterile drapes is bearing down,
 lab biohazard transport bag separate the
 patient's gown labia with your
 lab request form fingers to view
 examining table with stirrups the vaginal
walls.
PREPARATION OF EQUIPMENT 10. Lubricate the To prevent inaccurate
1. Select a speculum of the appopropriate size, and vaginal speculum result ( lubricant can
gather the equipment in the examining room. with warm water interfere with cytologic
2. Label each glass slide with the patient's name, rather than studies). Warm water is
and the letter "E", "C", OR "V" to differentiate lubricating jelly used to prevent
ENDOCERVICAL, CERVICAL. and if a specimen is contraction of the vaginal
VAGINAL SPECIMENS to be taken muscles.
11. Insert the index To prevent discomfort on
Planning & Implementation and middle the part of the client.
ACTION RATIONALE fingers of the
1. Explain the To gain cooperation. To nondominant
procedure to the prevent the spread of hand 2.5cm into
patient and wash microorganisms. the vaginal
your hands entrance. Spread
2. Place the client in To facilitate relaxation of these fingers and
lithotomy the abdominal muscles exert pressure
position and visualization of down on the
pelvic cavity and posterior wall.
external genitalia. 12. Hold the
3. Drape the client To provide privacy. speculum in the
bycovering her opposite hand
abdomen with the blades
extending her between curled
legs, exposing index and middle
only the part to fingers
be examined. 13. Ask the client to To help open the vaginal
4. Perform perineal To eliminate or lessen the bear down. orifice more and to relax
washing applying rpesence of the perineal muscles.
the nine strokes. microorganisms on the 14. Insert the To facilitate the insertion
part to be examined. speculum and prevent trauma to
5. Wear sterile To prevent the spread of obliquely and the vaginal wall.
gloves microorganisms. downward at a
6. Inspect the To check for presence of 45-degree angle
external genitalia. irritation, inflammation, toward the
or redness in the posterior wall
surrounding genitalia. with the blades in
7. Press the anterior To assess the Skene's closed position.
wall of the glands. (The crease of
vagina with your the blades is
finger. directed at 4 to 8
8. Palpate the To assess the Bartholin's o'clock.)
Bartholin's glands. 15. Rotate the To facilitate easy
glands at 5-7 speculum slowly visualization of the
o'clock applying to horizontal cervix.
a little pressure position.
on the site. 16. Open the blades To steady the open
9. Request the client To assess for the presence of the speculum position of the speculum
to bear down. of rectocele or cystocele. and tighten the for easy visualization of
While the client screw at the side. the pelvic cavity.
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 17. Assess the cervix To differentiate the
and record the normal from the
following: abnormal
a. Shape of the os
b. Color
c. Size
d. Position
e. Surface
characteristics
f. Discharges
18. Obtain a
specimen for Pap
Smear
19. Remove To prevent discomfort on
thespeculum by the part of the client.
loosening the
screw, and PRACTICING SAFETY BARRIERS IN
closing it back to CHEMOTHERAPY
oblique position
20. Dispose of To prevent the spread of RATIONALE
equipment microorganisms. 1. To reduce exposure of the nurse when
appropriately handling the drug
21. Remove the To provide comfort. 2. To handle and prepare drugs in a class II
drape. Clean and biological safety cabinet.
dry the client's
perineum. Assist EQUIPMENT
her as needed to a  Prescribe drug or drugs
sitting position  Patient medication record and chart
on the examining  long-sleeve gown
table.  Latex powder-free surgical gloves
 Face shield or goggles
 Eyewash
EVALUATION & DOCUMENTATION  Plastic absorbent pads
1. Normal and abnormal findings  Sterile gauze pads
2. Date and time the procedure was done  Shoe covers
3. Health personnel who performed the procedure  IV tubings with Iuer-lock fittings
4. Reaction of the client about the procedure  IV controller pump (if available)
5. Date of come back for the result and follow up
 IV solution
6. Smeared, fixated specimen sent to laboratory
with requisition included  Diluent, if necessary
 Medication labels
 Class II biological safety cabinet
 Disposable towel
 Hydrophobic filter or dispensing pin
 18g needle
 Syringe and needles of various size
 Impervious containers labeled CAUTION:
BIOHAZARD for disposal of any unused drug
or equipment

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EQUIPMENT B. DISPOSAL OF SUPPLIES AND UNUSED
(CHEMOTHEERAPEUTIC SPILL KIT) DRUGS
 2 pairs of gloves (for double gloving) C. MANAGEMENT OF
 Goggles CHEMOTHERAPEUTIC SPILLS
 Mask SPILL ON HARD SURFACE
 Disposable dustpan SPILL ON PERSONNEL/ PATIENT
 Water-resistant, non permeable, long-sleeve
gown with cuffs and back closure EVALUATION AND DOCUMENTATION
 Container of desiccant powder or granules (to 1. Document drug dosage, site, and any occurrence
absorb wet contents) of extravasation including estimated amount of
 2 diposable pads puncture proof , leak-proof drug.
2. Indicate needle type and site.
container labeled BIOHAZARD WASTE
3. Report amount and type of flushing solution.
4. Describe site’s condition after treatment.
EQUIPMENT (PREPARATION)
1. Verify drug, dosage, and administration route. 5. Document adverse reaction.
2. Make sure you know the immediate and 6. Note patient’s tolerance of treatment.
7. Record topic discussed with patient and family.
delayed adverse effects
3. Follow administration guidelines.

PLANNING AN DIMPLEMENTATION PRACTICING SAFETY BARRIERS IN

1. Wash hands before and after preparation and RADIATION
administration
2. Assess patient’s physical condition and medical DEFINITION
history
3. Determine best site to give drug. RADIATION THERAPY (radiotherapy)
4. Continuous infusion of vesicant drug should be  Is the treatment of benign and malignant
done through a central venous line or vascular diseases with ionizing radiation.
access device
Alert: Do not mix chemotherapeutic drugs with RATIONALE
1. To deliver a precisely measured does of
other drugs. If you have questions or concern,
talk with the physician or pharmacist before irradiation to a defined tumor volume with
minimal damage to surrounding healthy tissues.
giving the drug.
5. Double-check chart for the complete 2. To allow effective palliation or prevention of
cancer, with minimal morbidity.
chemotherapy protocol order, including
patient’s name, drug’s name, dosage, route,
rate, and frequency of administration. EQUIPEMENTS
6. Wear gloves through all stages of handling the 1. Film badge or pocket dosimeter
drug. 2. RADIATION PRECAUTION sign
3. RADIATION PRECAUTION
7. Before giving drug, perform a new
venipuncture proximal to the old site. 4. Warning label
Alert: Avoid using an existing IV line. Never 5. Male T-binder and two sanitary napkins with
safety pin (if Burnett applicator is being used)
test vein patency with chemotherapeutic drug.
6. Masking tape
7. Long-handled forceps
A. MANAGING EXTRAVASTION:
8. Optional: Lead shield and lead strip
9. Lead-lined container

PLANNING AND IMPLEMENTATION

1. Explain the treatment and its goals to the
patient. Before treatment begins, review
radiation safety procedures, visitation policies,
potential adverse effects, and interventions for
those effects. Also review long-term concerns
and home care issues.

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 2. Place the RADIATION PRECAUTION sign on
the door.
3. Check to see that informed consent has been
obtained
4. Ensure that all laboratory tests are performed
before beginning treatment.
5. Affix a RADIATION PRECAUTION warning
label to the patient’s identification wristband.
6. Affix warning labels to the patient’s chart and
Kardex.
7. Wear a film badge or dosimeter at waist level
during the entire shift.
8. Provide essential nursing care only; omit bed
baths. If ordered, provide perineal care, making
sure that wipes, sanitary pads, and similar
items are bagged correctly and monitored.
(Refer to facility’s radiation policy)

EVALUATION & DOCUMENTATION

1. Document drug dosage, and monitor for any
adverse reaction.
2. Radiation precaution maintained

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