Skills Laboratory:

PERFORMING
BREAST SELF – EXAMINATION
Jonnafe G. Gayatin, RMT, RN, MAN

Note: This presentation is made for educational purposes

and must be treated in respect to privacy and
confidentiality.
 • The best time to do a breast self-
Special exam is right after your period,
Consideration: when breasts are not tender or
swollen.
 STEPS RATIONALE
1. Remove any clothing that is For better
above your waist and stand facing a visualization of
mirror with your arms hanging the breast.
down to your side.
STEPS:
2. Look for any change in the
surface of your breasts, such as
dimpling, puckering, scaliness or
any other changes in the surface of
your skin from what you have
observed the last time.
Areola and
Nipple

• Assess for size, shape, color, symmetry,

lesions or discharges

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Abnormal
Findings during
Inspection
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 • Females: Rounded shape; slightly unequal
in size; generally symmetric
• Males: Breasts even with chest wall; if
obese: may be similar in shape to female
breasts
Normal • Skin uniform in color, smooth and intact
Findings: (some may have stretch marks, moles etc.)
• Areola color may be light pink to dark
brown. Irregular placement of sebaceous
glans (Montgomery’s tubercles). Nipples
pointing in the same direction
• No tenderness, masses, nodules or nipple
discharge
 STEPS RATIONALE
3. Slowly turn to each side to allow a Lactating
full view of both sides of both mothers may
breasts. Examine your areola and see a little
your nipple for any changes, such as encrusted
scaly skin or newly inverted nipple. material on the
nipple itself.
STEPS:
4. Continue to stand facing the
mirror and lift your arms up over
your head (straight up). Hold them
there and look for the same
symptoms (mentioned earlier).
Continue while slowly turning to
each side. Don’t be in a rush, move
slow enough to see everything.
 STEPS RATIONALE
5. While still facing the mirror, place Accentuates
your hands on your hips and push retraction of
inward and downward, flexing the the breast
chest muscles under your breasts. tissue.
Again, look for the same symptoms
(as mentioned earlier)
STEPS:
6. Keep your hands on your hips and
lean forward, allowing your breasts
to hang freely away from the chest.
Watch the breast surfaces as they
move. You are looking for the same
symptoms (mentioned earlier).
 Inspection of the Breast
• Source: Berman, A., Snyder, S. & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, Process and Practice (10th ed.). Pearson Education Limited. page 596.
 STEPS RATIONALE
7. Lie on your back, on a bed or other This position
flat surface. Elevate your shoulder distributes the
(the side you are examining) with a breast tissue
folded towel or pillow. Place your more evenly on
hand behind your head. the chest.
If too much breast tissue falls to the
STEPS: side and under your arm, and your
nipple is not pointing directly up
toward the ceiling, you may need to
assume a side lying position. (To do
that, lie on your right side to examine
your left breast, and pull your left
shoulder down onto the folded
towel.)
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 STEPS RATIONALE
8. Use the pads of your three
middle fingers on your left hand to
feel for lumps or thickening. Your
finger pads are the top third of
each finger.
STEPS:
9. Press firmly enough to know
how your breast feels. A firm ridge
in the lower curve of each breast is
normal. Move around the breast in
a set way. Either circle, up and
down, or the wedge.
BREAST PALPATION • Source: Berman, A., Snyder, S. & Frandsen, G. (2016). Kozier &
TECHNIQUES Erb’s fundamentals of nursing: Concepts, Process and Practice
(10th ed.). Pearson Education Limited. page 596.
 • After palpation, compress each nipple
to determine the presence of any
discharge.

Note: • If discharge is present, milk the breast

along its radius to identify the
discharge producing lobe. Assess any
discharge for amount, color,
consistency, and odor. Note any
tenderness on palpation.
 STEPS RATIONALE
10. Check your entire breast using a
lengthwise strip pattern. Feel all of
the tissue from the collarbone to the
bra-line and from the armpit to the
breast bone. Start in the armpit and
work down to the bottom of the bra-
STEPS: line. Move one finger-width toward
the middle and work up to the
collarbone. Repeat until you have
covered the entire breast. Repeat
this procedure on your left breast.
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 STEPS RATIONALE
11. Move your fingers in small,
coin-sized circles using different
levels of pressure to examine all
the breast tissue. Move in a
STEPS:
spiral pattern around your entire
breast. Avoid lifting your fingers
away from the skin as you feel
for lumps, unusual thickness, or
changes of any kind.
 STEPS RATIONALE
12. If you find changes, see your doctor right
away.
A. Any new lump. It may not be painful to
touch.
B. Unusual thick areas.
STEPS: C. Sticky or bloody discharge from your
nipples.
D. Any changes in the skin of your breast or
nipples, such a puckering or dimpling.
E. An unusual increase in the size of one
breast.
F. If one breast is unusually lower than the
other.
Summary: BSE in
Pictures
DOCUMENTATION:
If you detect a
mass, record the
following data:
Skills Laboratory:
PERFORMING TESTICULAR
SELF – EXAMINATION
Jonnafe G. Gayatin, RMT, RN, MAN

Note: This presentation is made for educational

purposes and must be treated in respect to
privacy and confidentiality.
 For early testicular
Purpose: problems and
cancer detection.
1. Perform testicular self-
examination every month.
2. Men between the ages of
15 and 40 should perform Special
monthly TSEs around the Considerations:
same time each month.
3. Client should be
comfortable and relaxed.
 STEPS RATIONALE

1. Before doing a testicular This is when

self examination, make the structures
STEPS: sure that you take a nice in the scrotum
warm shower. Warm water would be
will loosen your skin on most relaxed.
your testicles, making it
easier to examine for
abnormalities and lumps
 STEPS RATIONALE
2. Stand in front of a Easy access to
mirror when performing a your scrotum.
testicular self-
examination. Stand on
STEPS: one leg on a chair, sink or
toilet and you will notice
that one of your testicles
is lower than the other.
This is perfectly normal.
What you want to insect
first is to see if there is
any swelling.
 STEPS
3. Place your thumb and
forefingers around one
testicle and feel gently
over the entire surface.
Roll the testicle gently
STEPS: between your thumb and
index fingers and note if
the surface is smooth or
has any bumps. The
normal surface of your
testicle should be smooth,
firm but not hard. Feel for
any abnormal lumps
RATIONALE
To check for any
abnormalities. Lumps
can be pea sized or
smaller/bigger. If you
feel a lump, go to a
hospital to get a
thorough check-up. This
might be a sign of
testicular cancer.
 STEPS RATIONALE
4. As you are feeling It is not unusual
around the testicle, for this structure
move upward to the to extend a bit
top and feel the behind the
STEPS:
epididymis. It is testicle.
shaped like a
comma and might
be a little bit tender.
 STEPS RATIONALE
5. Keep feeling the
epididymis. There is a small
tube at the top called the
spermatic tube. You should
STEPS: be able to feel the spermatic
cord between your thumb
and forefinger and it should
be soft and movable.

6. Repeat on the other

testicle.
Testicular Self
Examination

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Supplementary Learning Aids:
• Youtube links:

• https://www.youtube.com/watch?v=vbj4NwiQhk8&has_verified=1
ASSESSING CARDIAC
LANDMARKS
DENNIS C. ESCALONA, RN, MN, FPCHA, FPSQua
 §Equipment:
Saint Augustine

“You have made us

for yourself, O Lord,
and our heart is
restless until it rests
in you.”
 1. Position the client comfortably
in bed using the three desired
position:
NURSING A. Lying in a supine position with the
CONSIDERATIONS: head of the bed raised 30-45 degrees
B. Lying on his left side
C. Sitting up.
 1. 30 degree
angle
2. 45 – 60 degree
 2. To auscultate for high-
pitched sound related to
NURSING
CONSIDERATIONS: semilunar problems, lean
the patient forward while
sitting.
§High-pitched
sounds are best
heard with the
diaphragm of the
stethoscope.
 §Heart sounds are brief,
transient sounds produced
NURSING by valve opening and
CONSIDERATIONS: closure; they are divided
into systolic and diastolic
sounds.
 § Murmurs are produced by blood
flow turbulence and are more
prolonged than heart sounds; they
may be systolic, diastolic, or
NURSING continuous. They are graded by
CONSIDERATIONS:
intensity and are described by their
location and when they occur within
the cardiac cycle. Murmurs are
graded in intensity on a scale of 1 to
6. 
 §Rubs are high-pitched,
scratchy sounds often with 2
NURSING or 3 separate components,
CONSIDERATIONS: which may vary according to
body position; during
tachycardia, the sound may
be almost continuous.
 3. To auscultate low-
pitched sound, position
NURSING to left lateral
CONSIDERATIONS: recumbent.
4. Concentrate as you
listen for each sound.
5. Avoid auscultating
through clothing or wound
dressings.
6. Avoid picking up
extraneous sounds by
keeping the stethoscope
tubing off the patient’s
body and other surface.
7. Ask patient to
breathe normally and
to hold his breath
periodically to enhance
sounds that may be
difficult to hear.
 STEPS
1. Position patient using the
three recommended
positions.
2. Begin auscultating over
the aortic area, placing the
stethoscope over the second
intercostal space, along the
right sternal border.
RATIONALE
The position will vary
depending on whether
you are auscultating a
low or high-pitched
heart sounds
In the aortic area, the
blood moves from the
left ventricle during
systole, crossing the
aortic valve and flowing
through the aortic arch.
3. Then move to the
pulmonic area, located at
the second intercostal
space, at the left sternal
border.
4. Next, assess the tricuspid
area, which lies over the
fourth and fifth intercostal
spaces, along the left
sternal border.
In the pulmonic area, blood
ejected from the right ventricle
during systole crosses the
pulmonic valve and flows
through the main pulmonary
artery.
In the tricuspid area, sound
reflect movement from the right
atrium across the tricuspid valve,
filling the right ventricle during
diastole.
5. Finally, listen over In the mitral area,
the mitral area, also called the apical
located at the fifth area, sounds
intercostal space, left represent blood flow
sternal border across the mitral
midclavicular line valve and left
ventricular filling
during diastole
NCM-101 MISS GAYATIN

FEAR>subjective

URINE OUTPUT>objective

ITCHINESS>subjective

RASHES>objective

BLOOD TYPE>objective

CHEST TIGHTNESS>subjective

HEADACHE>subjective

HOPELESSNESS>subjective

PALLOR>objective

BODY WEAKNESS>objective

WHERE IS THE LUMP?>closed

WHEN DID THE PAIN START?>closed

ARE YOU NERVOUS?>closed

HOW DO YOU FEEL LATELY?>open-ended

WHAT ARE YOUR DOUBTS?>open-ended

WHAT MADE YOU DECIDE TO SEEK COSULT?>open-ended

HOW DID YOU COPE WITH THIS?>open-ended

WHAT CAN I DO TO HELP?>open-ended

DOES IT HURT?>closed

DID YOU TAKE ANY PAIN MEDICATION?>closed

INTERVIEWWING IN THE PATIENT>assessment

FORMULATING GOALS>planning

ADMINISTERING MEDICATIONS>implementation

IDENTIFYING CLIENTS NEEDS>diagnosis

SELECTING NURSING INTERVENTIONS>planning

IINTERPRETING LAB TEST RESULTS>diagnosis

PROVIDING A BACK RUB>implementation

MODIFYING THE CARE PLAN>evaluation

RECHECKING RESPIRATORY>evaluation

PALPATING CLIENTS ABDOMEN>assessment

MISS GAYATIN

BREAST AND TESTICLE

NORMALLY, ONE BREAST IS SLIGHTLY BIGGER THAN THE OTHER

-TRUE

WHEN PALPATING FOR LUMPS WHILE PERFORMING BSE/TSE OF THE FINGER SHOULD BE USED

-FASLE

HOW OFTEN SHOULD TESTICULAR SELF- EXAMINATION BE DONE?

-ONCE A MONTH

THE NURSRE SHOULD ADVICE CLIENTS TO START TSE AT WHICH AGE?

- 7 YEARS OLD

WHEN IS THE BEST TIME TO CONDUCT BREAST SELF-EXAMINATION?

-ONE WEEK AFTER MENSTUATION

THE NURSE SHOULD ADVICE CLIENTS TO START TSE AT WHICH AGE?

-15 YEARS OLD