HA LEC TOPIC 4: Breasts.Genitalia.Rectum.Anus.Musculoskeletal.Neurological

MALE BREAST

• Small amount breast of glandular tissue

FEMALE BREAST

• majority of breast is glandular tissue

BREAST CANCER

• second to lung cancer as the leading cause of death in women with cancer.

Early breast cancer detection

• 20s and 30s

• 20 yrs old and older need to report any breast changes to a health care

• 20 to 40 clinical breast examination by a health care provider every 3 yrs

• Older than 40 annually

• WOMEN AT INCREASED RISK CONSIDER ADDITIONAL TESTING MRI

FEMALE BREASTS (INSPECT)

• SIZE AND SYMMETRY

• COMMON FOR ONE BREAST TO BE SMALLER

• CONTOUR OR SHAPE

• COLOR

• NIPPLE AND AREOLA

FEMALE BREASTS (PALPATION)

• vertical

• circular

• radial or wedge technique

MALE BREASTS (INSPECT)

• nipple and areola for NODULES, EDEMA AND ULCERATION

• Breast enlargement

• enlarged male breast reulsts from obesity or glandular enlargement

• MEN AT HIGH RISK MAY BE SCHEDULED BY THEIR HEALTH CARE PROVIDER FOR ROUTINE MAMMOGRAMS

ABDOMEN

• COMPLEX ASSESSMENT COZ OGRANS LOCATAED IN ABDOMINAL CAVITY

• INSPECT MUNA THEN AUSCULTATION (YAN LANG)

ABDOMEN INSPECTION

• SKIN

• UMBILICUS

• CONTOUR AND SYMMETRY

• ENLARGED ORGANS OR MASSES

• MOVEMENTS OR PULSATIONS

ABDOMEN AUSCULTATION

• BOWEL MOTILITY

  1. peristalsis

  2. borborygmi

     • VASCULAR SOUNDS

     1. Bruits

     • KIDNEY TENDERNESS

ABDOMEN PALPATION

• DETECTS TENDERNESS, DISTENTION OR MASSES

• LIGHT OR DEEP AS APPROPRIATE

• AORTIC PULSATION

TEST FOR APPENDICITIS

• Rebound tenderness

• Rovsing’s Sign

• Psoas Sign

• Obturator Sign

• Dunphy Sign

• McBurney’s Sign

REBOUND TENDERNESS

• pain upon removal of pressure rather than application of pressure to the abdomen

• ALSO CALLED BLUMBERG SIGN

Rovsing’s Sign

• pain in the right lower quadrant in response to lef-sided palpation

PSOAS SIGN

• elicited on flexing the right hip against resistance

• RLQ pain may be elicated on passive extension of the right hip

OBTURATOR SIGNS

• discomfort fely by the patient on the slow internal movement of the hip joint, while the right knee is flexed.

DUNPHY SIGN

• Cough sign (sharp pain in the right lower quadrant after a voluntary cough)

McBurney’s Sign

• positive when significant pain is elicited by palpating this area in the RLQ

• this could mean appendicitis

TEST FOR CHOLECYSTITIS (MURPHY’S SIGN)

• accentuated sharp pain causes the client to hold breath

• pinapalpate muna gallbladder area media gang sa midclavicular line habang nakahiga is patient tapos sabihin inhale ng malalim which expands yung lungs and para ma push yung gallbladder against the examiner’s fingertips

• positive if the patient abruptly ceases inhaling due to pain.

FEMALE GENITALIA AND REPRODUCTIVE TRACT

• assessment includes internal and external organs

• understand cultural sensitivity

• identify changes across the life span

• USES INSPECTION AND PALPATION

MALE GENITALIA

• Assesses the integrity of the external genitalia, inguinal ring, and canal

• use a calm, gentle approach to lessen the patient’s anxiety

ABNORMALITIES IN ANUS AND RECTUM

• HEMORRHOIDS

• ANAL FISSURES

• ANAL FISTULAS

Musculoskeletal System (INSPECTION)

• Gait

• Posture

  • Standing

  • Sitting

MUSCULOSKELETAL SYSTEM

• ASSESS THE

  • LORDOSIS

  • KYPHOSIS

  • SCOLIOSIS

MUSCULOSKLETAL SYSTEM (PALPATION)

• RANGE OF JOINT MOTION

MUSCULOSKELETAL SYSTEM RANGE OF MOTION

• GONIOMETER

• Muscle tone and Strength

  • Hypertonicity

  • Hypotonicity

  • Atrophy

NEUROLOGICAL SYSTEM

• Responsible for many functions

• requires time and attention to detail

• considered during evaluation

  • LEVEL OF CONSCIOUSNESS (LOC)

• PHYSICAL STATUS

• CHIEF COMPLAINT

NEUROLOGICAL SYSTEM

• MENTAL AND EMOTIONAL STATUS

• MINI-MENTAL STATE EXAMINATION

• CULTURAL CONSIDERATIONS

• DELIRIUM

MMSE SAMPLE QUESTIONS

• ORIENTATION TO TIME

• REGISTRATION

• NAMING

• READING

LEVEL OF CONSCOISNESS

• GLASGOW COMA SCALE

BEHAVIOR AND APPEARANCE

• NONVERBAL AND VERBAL

LANGUAGE

• APHASIA

  • SENSORY (RECEPTIVE)

  • MOTOR (EXPRESSIVE)

NEUROLOGICAL SYSTEM

• INTELLECTUAL FUNCTION

  • MEMORY

  • KNOELEDGE

  • ABSTRACT THINKING

  • ASSOCIATION

  • JUDMENT

    • CRANIAL NERVE FUNCTION

RELEXES

0 - NO RESPONSE

1+ : ASLUGGISH /DIMINISHED

2+ : ACTIVE / EXPECTED RESPONSE

3+ : MORE BRISK THAN EXPECTED, SLIGHTLY HYPERACTIVE

4+ : BRISK AND HYPERACTIVE WITH INTERMITTENT OR TRANSIENT CLONUS

MOTOR AND CEREBELLAR SYSTEMS

• ASSESS CONDITION AND MOVEMENT OF MUSCLES

• EVALUATE BALANCE

• ROMBERG TEST

• ASSESS COORDINATION

  • RAPID ALTERNATING MOVEMENT

  • RAPID ALTERNATING FINGER

  • POINT-TO-POINT FINGER

ROMBERG TEST

• SED TO INVESTIGATE THE CAUSE OF LOSS OF MOTOR COORDINATION (ATAXIA)

MENINGES

• ASSESS THE CLIENT’S NECK MOBILITY

• TEST FOR BRUDZINSKI’S SIGN

• TEST FOR KERNIG’S SIGN