Ateneo de Zamboanga University

College of Nursing

NURSING SKILLS OUTPUT (NSO) Report No. 9 Breast Self-examination Description: Breast self-examination is a self-screening a woman performs to detect early signs of breast cancer. Women may perform breast self exams to help detect changes in their breasts to call to their physicians' attention. Performing regular breast self exams can help women become familiar with the individual characteristics of their breasts and notice any changes. Materials/Equipment needed mirror

Procedure: It is the responsibility of the nurse to teach the client how to perform breast selfexamination. The nurse must give these instructions to the client: Undress and stand in front of the mirror with your arms at your sides. Look for any changes in the size or shape of your breasts or anything unusual such as discharge from the nipples or puckering or dimpling of the skin. Raise your arms above and behind your head, and press your hands together. Look for the same things as in step 1. Place the palms of your hands firmly on your hips; look again for any changes. Raise your left arm over your head. Examine your left breast by firmly pressing the fingers of your right hand down and around in a circular motion until you have examined every part of your breast. You may use the wedge section, circular or vertical strip examination method. Circular Method. Place the finger pads of your middle three fingers against the outer edge of the breast. Press gently in small, circular motions around the breast. Move your fingers in small circles around the breast until you reach the nipple. Try not to lift your fingers off the breast as you move from one point to another. Wedge Method. Place the finger pad of your middle three fingers against the outer edge of the breast. Press gently from the outer edge in a straight line toward the nipple. Move your fingers in parallel lines around the breast until each area is covered. Vertical Strip Method. Place the finger pad of your middle three fingers against the top outer edge of the breast. Press gently from the top outer edge down to the bottom edge. Continue up and down until you reach the inner aspect of the breast. Be sure to include the area between your breast and armpit and the nipple itself. If you feel a mass or lump, notify your health provider.

February 24, 2010 _______________________ Date Clinical Instructors initials Gently squeeze the nipple and look for any discharge. Mangaya-ay, Gio Ray T. BSN III A Page 1

Repeat steps 4 and 5 on your right breast.

Examination of the breast can also be done lying down: Ask the patient to lie down and place a small pillow or folded towel under her right shoulder. Instruct her to put her right hand behind her head. Place her left hand on the upper portion of her right breast with fingers together and flat. Body lotion may help to make this part of the exam easier. Instruct the patient to think of her breast as a face on a clock. Start at 12 o'clock and move toward 1 o'clock in small circular motions. Continue around the entire circle until she reaches 12 o'clock again. Keep her fingers flat and in constant contact with your breast. When the circle is complete, move in one inch toward the nipple and complete another circle around the clock. Continue in this pattern until she felt the entire breast. Make sure that she feels the upper outer areas that extend into her armpit. Place your fingers flat and directly on top of your nipple. Feel beneath the nipple for any changes. Gently press your nipple inward. It should move easily.
Diagram/Illustration

Nursing responsibilities Before the Procedure Explain to the client what a breast self-exam really is, including its benefits and limitations Allow time for the client to verbalize any concerns and misconceptions and address it accordingly _______________________ Clinical Instructors initials

February 24, 2010 Date Mangaya-ay, Gio Ray T. BSN III A

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Instruct the client that monthly breast self-exams are an option for all women beginning by age 20. Also explain to her that women who regularly examine their breasts become more aware of how their breasts normally feel, thus any changes/discomfort can be easily noticed and reported

During the procedure Inform the client that most breast tissue has some lumps or thick tissue. When in doubt about a particular lump, ask the client to check the other breast. If you find the same kind of lump in the same area on the other breast, both breasts are probably normal. Pay attention to any lump that feels much harder than the rest of your breast. Advise the client that soapy fingers slide easily across the breast and may increase her chances of detecting a change. Make sure that she feels the upper outer areas that extend into her armpit.

After the procedure Instruct the client to report any of these findings to the health care personnel:

Any new lump. It may or may not be painful to touch. Unusual thick areas. Sticky or bloody discharge from your nipples. Any changes in the skin of your breasts or nipples, such as puckering or dimpling. An unusual increase in the size of one breast. One breast unusually lower than the other.

Reference: Thompson, J., and Wilson, S. Health Assessment for Nursing Practice. MosbyYear Book, Inc., USA: 1996. http://www.thehealthblog.net/wp-content/uploads/2008/10/breast-selfexamination.jpg http://www.webmd.com/breast-cancer/guide/breast-self-exam?page=2 http://women.webmd.com/healthtool-self-breast-exam

Mangaya-ay, Gio Ray T. BSN III A Page 3

February 24, 2010 Date

_______________________ Clinical Instructors initials

Mangaya-ay, Gio Ray T. BSN III A Page 4