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What are developmental considerations for breasts after a baby is born?
- Birth: elevation of nipple
- Witch's milk secretion 5-7 days
What are developmental considerations for breasts in a child?
Growth begins in prepubertal period, period. Tanner stages of breast development
What are developmental considertions for breasts in pregnant women?
fuller, firmer, areola and nipples darken and enlarge. Third timester colostrum occurs
What developmental considerations for breasts in older women?
Ducts become fibrous, lose elasticity, less firm and pendulous
What are developmental concerns for breasts in older females?
fixed income, ignore changes, limitations due to age, loosening of ligaments
What are developmental concers of the breast for younger men?
Enlargement may be due to steroid use
What are cultual considerations for the breast?
- Hispanics-lower rate of breast cancer
- Africn americans-breast cancer may progress swiftly, home remedies used
- Hawaiians-highest mortality rate from breast cancer
- Jew's-increased incidence of breast cander
What are the different nodes?
supraclavicular, infraclavicular, parasternal, lateral, central, subscapular, anterior
What is the American Cancer Society recommendations for breast self exam?
Women in 20's, Women of any age report changes to provider
When should you get a mammogram?
By age 40 have screening, over 40 have screening annually
When should women have clinical breast exams?
Age 20-40 every 3 years, Yearly for women over 40, women with family history of breast cancer, yearly
What important health history should you ask for when doing breast exams for women?
Age, over 40?, family hx, age of menarch, age of menopause, pregnancies, oral contaceptives,
what important health history should you ask both genders when doing a breast exam?
Lump, thickening, pain, discharge, change in shape, size, nipple, medications, alcohol consumption, activity
What are the breast examination positions?
- Standing or sitting
- -hand at sides
- -hands behind head
- -hands on hips
- -examine one side then the other
- -towel or pillow shoulder
- -hand behind head
On breast inspection what do you look for?
Lump, pulled in nipple, dimpling, dripping, redness, rashes, skin changes
What is the vertical palpation technique for breast exam?
Feel up to the collarbone, feel to bottom of rib cage, feel all armpit up and into arm muscle an down to ribs. Most likely to examine all breast tissue
What is the palpation technique for breast exam?
Go in spokes, remember to palpate nipple, palpate all the way to chest wall and clavicels, remember to palpate axilla
What are a few other palpation techniques for breast exam?
concentric circles, circular clockwise motion, axilla and tail of breast, palpate all the way to the chest wall
When do you do self-breast exams?
Once a month, encouraged for both genders
What are developmental concerns for infants related to female genitourinary assessment?
Have no pubic hair, labia majora is closed, proper hygiene may not be learned
What are developmental concerns for adolescents in regards to female genitourinary assessment?
Most 19 year olds are sexually active, std incidence is high in adolescents and young adults
What are developmental concerns for older adults in regards to female genitourinary assessment?
lack of mobility or joint dysfunction can cause pain in lithotomy position, atrophy and dryness of vaginal tissues
What are the Tanners Signs?
- Stage 1: perpubertal
- Stage 2: Few long, fine hairs @ labia majora
- Stage 3: Pubic hair begins to spread across pubic area
- Stage 4: Pubic hair is coarser like an adult but not spread all over, smaller pubic area
- Stage 5: Pubic hair spread all the way to the thighs
What are cultural considerations in regards to female genitourinary assessment?
- Mexican-American-donot expose to men or women
- Chinese-Exam of genitals is culturally distatsteful
- Middle eastern-women traditionally not examined by male doctors
- Sub-Saharan African-Female genital mutilation is practiced
What are additional cultural considerations?
- Amish-high status in traditional role of wife
- Appalachian-Matriarchal, status achieved with motherhood
- Arab-Gain status with age, care for children and husbands needs
- Chinese-role is confucian, to perpetuate family roles which is male dominance in structure
- Egyptian-pregnancy is expected within 1 year of marriage, status is achieved through pregnancy and birth of son
- Filipino-equal role with men in health, welfare and family finance
- Greek-pregnancy seen as time of great respect
- Iranian-prestige associated with having children
- Mexican-women maintains home and health of family
- Vietnamese-dutiful and respectful of husband and to make healthcare decisions
What is important health history questions in regards to female genitourinary assessment?
Reproductive health, menstral history, sexual activity history, lifestyle assessment, essential reproductive assessment functions, what else?
How to prepare to exam for female genitourinary assessment?
- Approach: inspection, palpation, internal exam
- Position: lithotomy
- Equipment: gloves, adequate lighting, drape, lubricant
- Patient instruction: patient to void before exam
What to inspect during the female genitourinary assessment?
External areas, labia, external oriface, perineal body, anus, mons pubis, etc
What two type of exams do you do when doing a female genitourinary exam?
Speculum and bimanual pelvic exam. Palpating for any masses or abnormalties
What does a pap smear test for?
Cancerous tissue, cervical dysplasia, any other abnormal cervical cells
What are different pathological issues with regards to female genitourinary exam?
Check for chancre, herpes lesions, bartholin's cyst, uterine fibroids, uterine prolapse, ovarian tumor, ovarian cyst, urinary incontinence (overflow, stress, urge), ectopic pregnancy.
What are developmental concerns of the infant in regard to male genitourinary assessment?
- Premature:undescended testes and few rugae
- Breech:scrotal edema and ecchymosis
- Hydroceles and hernias common in boys less than 2
- Decision to circumcise is culturally based
What are developmental concerns of the child/adolescents in regard to male genitourinary assessment?
Tanner staging, development of the penis/pubic hair. STD's high in adolescents
What are developmental concerns of the young adult in regard to male genitourinary assessment?
STD's high in young adults, testicular common from 18-34
What are develpmental concerns of the older adult in regard to male genitourinary assessment?
Pubic hair thins, penis appears atrophic and testicles smaller and slightly softer than a younger male. Prostate larger, scrotal sacs loses elasticity, decreased testosterone occur by age 50, decreased sperm count but still viable until age 70. impotence is increased
What are cultural considerations in regard to male genitourinary assessment?
Circumcision, not traditional in native americans or hispanics, traditional in jewish and muslim cultures, high incidence of circumcision
What do you need to ask in regard to health history of the male genitourinary assessment?
Urinary elimination history, sexual history, surgeries of illnesses, sexual function, any problems with the penis, testes and scrotum
What should you do in regard to male genitourinary physical assessment ?
Inspect, palpation, auscultation, eternal rectal exam. standing position, gloves, adequate lighting, drape, have patient void before exam
What do inspect and palpate in male genitourinary assessment?
penis, scrotum, inquinal area, rectum
What pathological issues in regard to male genitourinary assessment?
hernia, genital warts