Introduction
But before anything else, we need a
equipment that we are going to use in the
demonstration for assessing the breast
and lymphatic as well as neck and heart
vessels. A stethoscope, penlight or
movable exam light, watch, two second
centimeter ruler, gloves, small pillow, slide
for specimen, hand out on breast
examination and a trash bin.
After performing hand hygiene and
ensuring privacy, introduce yourself to the
patient, then identify the patient using 2
identifiers
Good morning sir, My name is jan vincent
ballesteros and im gonna be your nurse
for today! First thing that I just need to do
is what we called patient identification. I
told you who I am and I’d like you to tell
me who you are. First thing could you
please tell me your first same pls. Im just
gonna double check that with your name
band and could you also tell me your date
of birth? Excellent! You’re an aries,
Awesome both match!
What I plan to do now is to assess your
breast and lymphatic and also your neck
and heart vessels through palpating and
inspection. It is necessary to assess these
area to prevent any harmful diseases and
bring awareness if there is abnormality.
This will help us to identify your health
condition and also Rest assured that the
data that I will gathered is treated with
utmost care, privacy and confidentiality
and only professional health care workers
can only see the information. Is that okay
sir? Alright great!
so let me first assess your breast and
lymphatic but before that let me asks
questions first for my subjective data is
that okay sir? Great!
Let me just ask for your current symptoms
Do you have any changes in the breast?
Like swelling, redness, lumps, warmth,
dimpling, size, firmness, pain, discharge?)
None
How about in you past health history
Any previous problems with your breast
sir? Treatment or surgery?
Nonone none akoen ao g ha anone ha
nnone no one none no g kkasn nka
agbdhnk nakanjok a sh dj [ aja
B j dnl
How about in your family history, any
history of breast cancer?
Alright.
So lets come now to your lifestyle and
health practices
Do you use any hormones, contraceptives
or antidepressants?
How about exposure to radiation,
benzene, or asbestos?
Your usual diet sir? Intake of alcohol,
coffee, tea, soft drinks, and chocolate?
I drink coffee in the morning and
sometimes soft drinks. And sometimes I
eat chocolate but not every day.
Okay thankyou sir.
How about usual exercise pattern?
I exercise every morning starts at 6 am to
7 am
Okay thankyou for your cooperation
sir. I’m done taking your subjective
data.
Im gonna inspect the size, shape and
symmetry of you breast.
Normal breast are round, and symmetric
Can you stand for a minute sir to assess
your breast for any dimpling or retractions
during movements
It in an indication that there is an indication
of a possible mass underneath that area.
So put your hand up over your head, put
your hands on your hips, and flex your
pectoral muscle .
Ok thankyou sir, what I have notices is discrete, not tender, movable nodes In the
that it moves symmetrically and there central part.
were no retractions and militantly and I
doesn’t any lesion on the skin or anything So maam you have a normal breast and
abnormality. The nipples are symmetrical axillae. Thankyou maam.
and I don’t see any discharged. Document and report pertinent
So next thing im gonna do is to put you in assessment data  according to agency
a supine position or in a position where I policy.
can properly palpate your breast im gonna Next thing is Im gonna do now is to
put your hand over your head because it assess your heart and neck vessels.
helps to spread out the breast tissue.
To take the apical pulse began by
Palpate for the breast assessing for factors that can affect its
Inform the patient that the palpation shout rate and rhythm such as medical history,
not be painful. If they do feel any disease processes age, exercise,
discomfort they should let us know medication, temperature and sympathetic
stimulation.
Examine the whole breast with the pads of
your 3 fingers starting centrally at the But before anything else im going to ask
areola and palpating clockwise in every for subjective data maam is that okay?
increasing circle to cover the rest of the Okay great.
breast tissue and also the auxillary tail of Do you have any current symptoms like
the breast tissue which extends toward the chest pain, plapation, dizziness or swollen
axilla next is to plapte the nipple and ankle?
gently squiezze the nipple to see if it
reproduce any discharge. None.

So next in Im gonna palpate and inspect How about your past history maam,
your axillae. Any previous heart problems: heart defect,
First is to inspect for rashes or infection mumur, heart attack? None

Hold the elbow with one hand and use the Previous diagnosis of rheumatic fever,
three fingerpads of your other hand to hypertension, elevated cholesteol,
palpate firmly the axillary lymph notes. diabetes melitius? None

Palpate high into the axillae, moving Any heart surgery or cardiac balloon
downward against the rubs to feel for the intervention? None alright thankyou.
central notes. Continue down the posterior How about your family history maam
axillae to feel for the posterior nodes.
Hypertension?
Use bimanual palpation to feel for the
anterior axillary nodes Myocardial infarction?
Palpate down the inner aspect of the Coronary heart disease?
upper arm.
Elevated cholesterol?
Thankyou maam for your cooperation. Im
Diabetes mellitus?
done checking for your breast and
lympathic How about maam you lifestyle and health
practices?
There is no palpable notes, your axillae
have no rashes or any infection. It is Cigarette smoking patterns?
Life stress rate it from 1 -10. type and
amount?
5 its manageable stress. Stress in school
works.
Your diet and exercise pattern?
I eat 3 times a day usually vegetables.
And I exercise also everymorning.
Use of alcohol? No
Your sleep routine maam? Do you use
extra pillow, up to urine, and feels rested?
Yes, and I sleep around 10 pm and wake
up at 7 am.
Do you use any medication or treatments
for heart disease?
None
Self monitoring of heart rate or blood
pressure?
Yes
Do you usually Screen for blood pressure,
cholesterol and ecg? Yess
Do you have any CHD? No.
Okay thakyou maam for your cooperation.
Next thing im gonna do is to perform
physical assessment of your heart and
neck vessels.
Clean gloves are worn only when the
nurse maybe in contact with bodily fluids
or the patient isnt protective precaution
Hop the patient into a supine or sitting
position and expose his sternum and the
left side of his chest and ask the head to
turn into the left and right for the
assessment of neck vessels.
Inspect for the vein in the neck, it should
be flat. If you see the vein itself, large or
bulging that would be an indication of an
increase in pressure which is abnormal.
Auscultate carotid arteries for bruits.
Feel for its strength of the pulse, upstroke
it should be nice and smooth and strong.
Do the same thing in the other side.
Listen for the carotid artery using the bell
of the stethoscope for bruits. Ask the
patient to take a breath in and out.
Breath in and breath out maam, and
hold.
It should only hear the pulse, not any
swishing
Its normal because I didn’t hear any
sheezing sound
Palpate each carotid artery for amplitude
and countour of the pulse, elasticity of the
vessel, and thrills.
There is no elasticity of the pulse and the
pulse is normal and smooth
Inspect for jugular venous pulse
Measure jugular venous pressure.
It is anes cm which is normal because
under 3 cm is normal
Next thing is to move to your chest
maam.
Inspect for visible pulsations
I can see normal respiratory movement.
Palpate apical pulse for location, size,
strength and duration of the pulsation.
the apical pulse is located at the fifth
intercostal space at the left
midclavicular line
Palpate for abnormal pulsation or
vibrations at apex left sternal border
I can feel the beat of your pulse without
vibrations or any abnormalities.
Auscultate heart sound for rate and
rhythm apical and radial pulses, pulse rate
deficit s1, s2)
Now that i found the spot, let me just
clean my stethoscope
Warmth the diagram of the stethoscope in
the palm of your hands for 5 to 10 sec
then clean it with alcohol swab
Place the stethoscope and auscultate the Document and report pertinent
normal s1 and s2 heart sounds. Once you assessment data  according to agency
can hear s1 and s2 with regularity look at policy.
your watch, when the second hand
reaches a number on a dial or when a
digital display reaches a round number
begin taking the apical pulse counting the
first beat you hear as one
If the pulse is regular, count the beats for
30 seconds and multiply the total by 2
A normal heart rages 60 to 100 beats per
minute. If the pulse is irregular, count for a
full minute and listen for patterns of
irregularity with dysrhythmia for example
you might notice every third beats is
skipped.
Auscultate s1 and s2 heart sounds for
sound location and strength pattern
(louder/softer at locations and with
respiratory splitting of s1)
I heard s1 and s2, its normal. Not too loud
and not too soft
Auscultate for extra heart sounds and
mumurs systolic or diastolic, intensity
grade, pitch, quality, shape or pattern,
location, trans mission, effect or ventilation
and position)
Auscultate with the client in the left lateral
position and with the client sitting up,
leaning forward and exhaling.
After assessing discuss your findings with
the patient.
Okay sir your heart beat is —- which its
good and its between the normal range
and there is no any murmur sound or
swishing.
Help him in the comfortable position and
discuss your findings if appropriate. Clean
the earpieces and diaphragm of the
stethoscope with an alochol swab
routinely. And discard the swab ina
appropriate receptacle
Perform hand hygiene