Breast self examination (BSE) is to be performed each month in addition to an annual

mammogram or a clinical exam. Knowing your cyclical changes, what is normal for you,
and what regular monthly changes in the breast feel like is the best way to keep an eye
on your breast health. Breast tissue extends from under your nipple and areola up
toward your armpit.
Difficulty: Easy

Time Required: 15 minutes a month

What You Need:

• A mirror which lets you see both breasts
• A pillow for your head and shoulders
• Privacy
1. Make a regular date for your BSE
Photo Courtesy of National Cancer Institute
If you are pre-menopausal: Set a regular time to examine your breasts a few days
after your period ends, when hormone levels are relatively stable and breasts are less
tender.
If you are already menopausal (have not had a period for a year or more): Pick a
particular day of the month to do the exam, and then repeat your BSE on that day each
month.
2. Visual Exam - Hands on Hips
Photo Courtesy of National Cancer Institute
In the privacy of your bathroom, strip to the waist and stand before a mirror. You will
need to see both breasts at the same time. Stand with your hands on your hips and
check the appearance of your breasts. Look at size, shape, and contour. Note changes,
if any, in the skin color or texture. Look at the nipples and areolas, to see how healthy
they look.
3. Visual Exam - Arms Over Your Head
Photo Courtesy of National Cancer Institute
Still standing in front of the mirror, raise your arms over your head and see if your
breasts move in the same way, and note any differences. Look at size, shape, and
drape, checking for symmetry. Pay attention to your nipples and areolas, to see if you
have any dimples, bumps, or retraction (indentation). Look up toward your armpits and
note if there is any swelling where your lymph nodes are (lower armpit area).
4. Manual Exam - Stand and Stroke
Photo Courtesy of National Cancer Institute
Raise your left arm overhead, and use your right-hand fingers to apply gentle pressure
to the left breast. Stroke from the top to the bottom of the breast, moving across from
the inside of the breast all the way into your armpit area. You can also use a circular
motion, being sure to cover the entire breast area. Take note of any changes in texture,
color, or size. Switch sides and repeat. This is best done in the shower, as wet skin will
have the least resistance to the friction of your fingers.
5. Manual Exam - Check Your Nipples
Photo Courtesy of National Cancer Institute
Still facing the mirror, lower both arms. With the index and middle fingers of your right
hand, gently squeeze the left nipple and pull forward. Does the nipple spring back into
place? Does it pull back into the breast? Note whether or not any fluid leaks out.
Reverse your hands and check the right nipple in the same way.
6. Manual Exam - Recline and Stroke
Photo Courtesy of National Cancer Institute
This is best done in your bedroom, where you can lie down. Place a pillow on the bed
so that you can lie with both your head and shoulders on the pillow. Lie down and put
your left hand behind your head. Use your right hand to stroke the breast and underarm,
as you did in step 4. Take note of any changes in texture, color, or size. Switch sides
and repeat.
7. Tips For Doing Your BSE
• Mark your calendar to remind yourself to do your BSE regularly. This is a good
way to prevent worry if find a normal cyclic change.
• Stay relaxed and breathe normally as you do your BSE. Becoming tense will
produce some knots that you may mistake for something worrisome.
• Report any changes or unusual pain to your doctor or nurse practitioner. Keep a
log of changes, if that helps you remember.
• Remember to have an annual clinical exam and a mammogram.
During a breast self-exam, you may notice lumps or a change in texture. Knowing the
difference between harmless and harmful breast lumps is important to your health.

There are three kinds of benign breast lumps:

• Cysts
• Fibroadenomas
• Pseudolumps
There is one type of malignant breast lump: Breast cancer
Breast Lumps in Detail:

Breast Cysts:
What is it? This is a harmless (benign) fluid - filled sac of tissue. It can grow right within
the breast tissue.

What does it feel like? This breast lump will feel smooth and squishy. If you are
pressing on a cyst, it will have some give to it, like a water balloon. A cyst can move
around and can change in size during your menstrual cycle.

Where is it? Breast cysts can be located near the surface, or deeper inside, close to
your chest wall. If the cyst is closer to the surface, it is easy to find and easy to
distinguish from other lumps. But if it is deeper inside, it's more difficult to distinguish it
from other kinds of breast lumps, because when you press on it, you're actually trying to
work through layers of breast tissue, which may be dense and firm.
Treatment: Your doctor can help you determine that a lump is a harmless cyst, by doing
a fine needle aspiration with a syringe. This procedure removes the fluid from inside the
cyst, which deflates and most likely will not return.

When does it appear? Commonly appears in women who are in their 30's, 40's and
50's. They are most often found in women who are nearing menopause.

Does it show up on a mammogram?

Yes. See what breast cysts look like on a mammogram.

Breast Fibroadenomas:
What is it? This is a benign group of cells that support other kinds of cells in your
breast. These are made of fibrous and glandular tissues.

What does it feel like? This will feel like a round breast lump, and can be hard or firm.
It can be moved around during a breast self-exam.

Where is it? These can be located near the surface of the breast and are easily felt.

Treatment: A fibroadenoma can be removed, if needed, with a lumpectomy, a laser

ablation,or cryoablation. If there is some doubt about the fibroadenoma, it can biopsied,
to make sure that it is harmless.

When does it appear? Usually appears in teens and younger women. May occur
during pregnancy. Not common in post-menopausal women.

Does it show up on a mammogram?

Yes. See a breast fibroadenoma on a mammogram.

Breast Pseudolumps:
What is it? These are benign, and may be scar tissue, hardened silicone, necrotic
(dead) fat, or a rib bone pressing into breast tissue and compressing it.

What does it feel like? This kind of breast lump can feel quite hard and usually doesn't
change shape or size during a menstrual cycle. It may or may not be movable,
depending on what it is actually composed of.

Where is it? Pseudolumps can be located near the surface, or deeper inside the
breast, close to the chest wall.

Treatment: To be sure that a pseudolump is harmless, get a mammogram and

ultrasound, and if those are not clear, have a needle biopsy done, so that a tissue
sample can be analyzed by a pathologist. If it is bothersome, you can have it surgically
removed.
When does it appear? If you've previously had breast surgery or enhancement done,
or if a rib has shifted, then a pseudolump may occur.

Can Pseudolumps Show up on a Mammogram?

Maybe. Find out more about breast pseudolumps and mammograms.

Breast Cancer:
What is it? A malignant lump that is made of abnormal breast tissue cells, growing in an
uncontrolled way.

What does it feel like? A malignant breast lump will have an irregular shape (not
round) with a pebbly surface, somewhat like a golf ball. It will be very hard, like a slice of
raw carrot. It may not be movable during a breast self-exam, but since tissue around it
may move, it's sometimes hard to know if the lump is moving, or if healthy tissue around
it is moving. A clinical breast exam and a mammogram will help to clear up the
diagnosis. A needle biopsy would provide more information about the lump.

Where is it? Breast cancer can be located near the surface, or deeper inside the
breast, close to the chest wall. It can also occur in the armpit area, where there is more
breast tissue.

Treatment: The lump itself may be treated with one, or a combination of therapies:
surgery, chemotherapy, radiation, and hormone suppression therapy. Talking with your
doctor will help you decide on the best treatment plan for your particular diagnosis.

When does it appear? Breast cancer may appear in women who are pubescent, in
their fertile years, peri-menopausal, or postmenopausal.
Can breast cancer show up on a mammogram?
Breast Cancer Tumors:
A cancerous tumor in the breast is a mass of breast tissue that is growing in an
abnormal, uncontrolled way. The tumor may invade surrounding tissue, or shed cells
into the bloodstream or lymph system.
What They Feel Like:
A breast tumor is very hard, like a bit of raw carrot. It will have an irregular shape, and
feel bumpy (not smooth). It may not be moveable during a breast self-exam, but since
tissue around it may move, it’s sometimes hard to know if the lump is moving, or if
healthy tissue around it is moving.
How They Appear on Mammograms:
A breast tumor is a dense mass and will appear whiter than any tissue around it. Benign
masses usually are round or oval in shape, but a tumor may be partially round, with a
spiked or irregular outline as part of its circumference. If a mass has a multi-pointed
star-shaped outline, it is described as spiculated. Keep in mind that to the untrained
eye, other masses may appear like tumors, but are not. Only a trained radiologist
should make the call.
What Happens If You Have a Tumor:
If your mammogram shows a very dense mass which appears to be a tumor, you will
need to have an ultrasound of that particular breast mass. If that image shows a mass
that has an irregular outline, or appears to have fuzzy edges and is pressing on tissue
around it, then you will need to have a biopsy done of the mass. An analysis of the
tissue sample from the mass is the most accurate way to diagnose its actual nature.
What Causes Breast Tumors:
Many factors may increase your risk for breast cancer, but we don’t yet know the exact
cause. The BRCA 1 and 2 genes, when they are healthy, act as tumor suppressor for
breast and ovarian tumors. But you may inherit mutated BRCA genes, or those genes
may become damaged from exposure to radiation or chemicals in your environment.
Some genetic mutations develop as part of the cancer.
Tumor Risk Increases With Age:
About 17 percent of women who were diagnosed with invasive breast cancer were in
their 40s, and 78 percent of women with invasive breast cancer were older than 50.

Definition
By Mayo Clinic staff

A testicular exam is an inspection of the appearance and feel of your testicles. You can
do a testicular exam yourself, typically standing in front of a mirror.
Routine testicular exams can give you a greater awareness of the condition of your
testicles and help you detect when changes occur. Testicular exams can also help you
identify potential testicular problems, such as testicular cancer. Lumps or other changes
found during a testicular exam aren't always a sign of cancer, but still need to be
checked by a doctor.

Why it's done

By Mayo Clinic staff

Doing regular testicular exams helps you learn the normal feel and appearance of your
testicles. That makes it easier to notice subtle but potentially serious changes, should
they occur. Routine testicular exams increase your chance of identifying testicular
cancer early, while it's relatively easy to treat.

Risks
By Mayo Clinic staff

A testicular exam doesn't pose any risks. If you notice a cause for concern, however, the
follow-up exam might lead to unnecessary worry and medical attention. For example, if
you discover a suspicious lump, you may end up having a procedure to remove tissue
for examination (biopsy). If it turns out the lump was noncancerous (benign), you might
feel that you've undergone an invasive procedure unnecessarily.
Testicular self-exams alone don't reduce the number of deaths from testicular cancer.
Because of the low incidence of testicular cancer and the potential for unnecessary
anxiety and intervention, some men choose not to do routine testicular exams.
How you prepare
By Mayo Clinic staff

No special preparation is necessary to do a testicular exam. The American Cancer

Society recommends doing a monthly testicular exam if you have certain risk factors for
testicular cancer, such as an undescended testicle, certain congenital abnormalities,
previous testicular cancer or a family history of testicular cancer. Some doctors,
however, recommend that all men do a monthly testicular self-exam beginning anytime
after puberty — preferably at about the same time every month.

What you can expect

By Mayo Clinic staff

CLICK TO ENLARGE
Testicular self-
examination

To do a testicular exam, stand unclothed in front of a mirror — preferably after a warm

bath or shower. Heat relaxes the scrotum, making it easier for you to check for anything
unusual. Then:
• Look for swelling. Hold your penis out of the way and examine the skin of the
scrotum.
• Examine each testicle with both hands. Place your index and middle fingers
under the testicle and your thumbs on top.
• Gently roll the testicle between your thumbs and fingers. Look and feel for
hard lumps, smooth rounded bumps or any change in the size, shape or
consistency of the testicle.
While you're doing the testicular exam, you may notice a few things about your testicles
that seem unusual — but aren't signs of cancer. For example:
• One of your testicles is larger than the other. It's normal for one testicle to be
slightly larger. It's only a cause for concern if there's a change in the size of one
of your testicles.
• You have bumps on the skin of your scrotum. This can be caused by ingrown
hairs, a rash or other skin problems.
• You feel a soft, ropy cord. This is a normal part of the scrotum called the
epididymis. It leads upward from the top of the back part of each testicle.
Results
By Mayo Clinic staff

Don't be embarrassed about contacting your doctor if you find a lump or other problem
during a testicular exam. It's especially important to contact your doctor if you notice any
of the following:
• A lump or swelling in a testicle or the scrotum
• Pain or discomfort in a testicle or the scrotum
• A change in the size of a testicle
• A change in the way a testicle feels
• A heavy feeling in the scrotum
• A dull ache in the lower abdomen, back or groin
Depending on the circumstances, your doctor may do a testicular exam followed by a
blood test, ultrasound or biopsy.
Remember, unusual signs and symptoms aren't necessarily due to testicular cancer —
but they still need to be checked out by a doctor. Testicular cancer is easiest to treat
when it's detected early. Even if your signs and symptoms are caused by something
other than testicular cancer, you may still need treatment.

Digital rectal exam

A digital rectal exam is an examination of the lower rectum. The doctor uses a gloved,
lubricated finger to check for abnormalities.
How the Test is Performed
The doctor will first examine the outside of the anus for hemorrhoids or fissures. Then
the doctor will put on a latex glove and insert a lubricated finger into the rectum. In
female patients, this exam may be done together with a pelvic exam.
How to Prepare for the Test
The doctor will ask you to try to relax before the test and to take a deep breath during
the actual insertion of the finger into the rectum.
How the Test Will Feel
You may feel mild discomfort during this test.
Why the Test is Performed
This test is performed for various reasons, but is most often done as part of a routine
yearly physical examination in both men and women.
In men, the test is used to examine the prostate, looking for abnormal enlargement or
other signs of prostate cancer.
In women, a digital rectal exam may be performed during a routine gynecologic
examination.
A digital rectal exam is also done to collect stool for testing for fecal occult (hidden)
blood as part of screening for colorectal cancer.
This procedure is also done before other tests, such as a colonoscopy, to make sure
nothing is blocking the rectum before inserting an instrument.
Normal Results
The digital rectal exam is usually treated as an initial screening examination. It is usually
done together with other tests to rule out abnormalities.
A "normal" finding is when the doctor does not feel any abnormalities -- but this test
does NOT completely rule out potential problems.
What Abnormal Results Mean
Any bleeding in the gastrointestinal tract calls for emergency care. Patients should be
evaluated in the emergency department for gastrointestinal bleeding (hemorrhage).
If tests reveal occult (hidden) blood, but there is no obvious hemorrhaging (bleeding),
the patient will undergo blood tests for anemia, followed by colonoscopy.
A male patient with an enlarged or nodular prostate will undergo a blood test of prostate
specific antigen (PSA test), and then possibly a prostate ultrasound and biopsy after
referral to a urologist.
Risks
The exam itself generally carries no risk, but it is possible to have a normal exam and
still have an occult (unidentified/hidden) source of bleeding.
ABG and ABB

Metabolic Acidosis

Risk factors: more ingestion of acids or less production of HCO3

Etiology: lactic acidosis, ketoacidosis, uremic acidosis; diarrhea (more bicarbonate

losses)

Patho: compensatory hyperventilation

Hyperkalemia: shift of acid from plasma to ICF

Low pH, less HCO3, PaCo2 normal or low if compensation is occurring

cardiac dysrhythmias & CNS dysfunction

headache, diarrhea, tremors

Sodium bicarbonate may be given when a patient is experiencing lactic acidosis

secondary to shock. It is administered cautiously because the carbon dioxide produced
crosses rapidly into the cells and may cause paradoxical worsening of intracellular
hypercarbia and acidosis.

Metabolic Acidosis

Nursing Responsibilities

Monitor cardiovascular status closely, noting: BP, PR and rhythm, capillary refill, warmth
and color of extremities

Institute safety precautions, such as: keeping bed side rails up, keeping bed brakes
locked, securing all invasive lines properly

Metabolic Alkalosis

Risk factors:

Hypovolemia (prolonged vomiting or gastric suctioning)

Excess aldosterone

Etiology:

Acid loss or base gain

Iatrogenic base administration

Prolonged vomiting (loss of HCL)

Renal excretion of HCO3 will fix the problem

Metabolic Alkalosis

Patho: respiratory compensation is limited/slow respirations

Hypokalemia: K+ moves from ECF to ICF due to hydrogen ions moving out of the cell
to ECF

Depleted body stores (K+):

Loop diuretics? NGT?

Signs and Symptoms:

cardiac dysrhythmias; tetany/seizures; confusion; muscle twitching, agitation

high pH; more HCO3; normal PaCo2 or elevated if compensation occurs

Metabolic Alkalosis

Nursing Responsibilities

Institute safety precautions, such as: keeping bed side rails up, keeping bed brakes
locked, securing all invasive lines properly

Monitor respiratory rate and pattern, lung sounds, skin color, and mental status

Provide tx to correct the underlying cause as ordered

Promote adequate hydration

Correct electrolyte deficits, particularly of K and Na as ordered

Respiratory Acidosis

Risk factors:

Excess acid in body fluids

Etiology:

Hypoventilation

COPD; Cystic Fibrosis; airway obstruction; spinal cord injury; CVA; respiratory
depressant drugs; inadequate mechanical ventilation

Respiratory Acidosis

Patho:

Hypercapnia; CO2 diffuses easily across biological membranes

Clinical:

Decreased pH

High PaCo2
HCO3 is normal or increased in renal compensation

Signs and Symptoms

Dyspnea, wheezing, tachypnea

Vasodilatation

Cardiac arrhythmias; tachycardia

Somnolence & decreased ventilation

Respiratory Acidosis

Nursing Responsibilities

Monitor ABG values

Administer low flow O2 therapy to a pt with chronic PCO2 above 50 mmHg

Position the patient in semi-Fowler’s or another comfortable position to ease the work
of breathing

Improve ventilation with bronchodilators; postural drainage; antibiotic thx; regular

coughing, turning, and deep breathing & mechanical ventilation as appropriate

Respiratory Acidosis

Nursing Responsibilities

Maintain a quiet, relaxing environment

Keep needed items within the patient’s reach

Monitor cardiovascular status, noting: BP, PR and rhythm, capillary refill, warmth and
color of extremities

Maintain fluid and electrolyte balance

Intervene to correct the underlying cause

Respiratory Alkalosis
Risk factors:

Relative excess of base in body fluids secondary to > ventilatory elimination of CO2;
pneumonia; shock; severe anemia

Etiology:

hypoxemia (<PaO2) causing rate & depth of ventilation to increase (hyperventilation)

Respiratory Alkalosis

Patho: Buffer response is to shift acid from ICF to the blood by moving HCO3 into the
cells in exchange of chloride

High pH; less PaC02; HCO3 normal or low due to compensation

nausea, vomiting, tingling of fingers, lightheadedness, inability to concentrate

Respiratory Alkalosis

Nursing Responsibilities

Monitor ABG values and respiratory rate and pattern

Institute and maintain seizure precautions as necessary

Assess sources of anxiety and intervene to help reduce anxiety

Encourage slow, deep breathing; instruct the patient to breathe into and out of a paper
bag, if necessary, to reverse hyperventilation

Assist the patient with activities as necessary

Arterial Blood Gases

Reflect oxygenation, gas exchange, and acid-base balance

PaO2 is the partial pressure of oxygen dissolved in arterial blood

SaO2 is the amount of oxygen bound to hemoglobin

Oxygen is transported from the alveoli into the plasma

Arterial Blood Gases

Ranges

PaO2 80 - 100 mm Hg at sea level

< 80 mm Hg = hypoxemia

< 60 mm Hg may be seen in COPD patients

< 40 mm Hg is life threatening

SaO2 93 - 100 % is a normal saturation

Hypoxia is decreased oxygen at the tissue level

Arterial Blood Gas Interpretation

pH: negative log of H+ concentration

In blood:

Normal range: 7.35 - 7.45

Acidosis = pH less than 7.35

Alkalosis = pH greater than 7.45

A pH < 7.0 or > 7.8 can cause death

Arterial Blood Gas Interpretation

PaCO2: partial pressure of carbon dioxide dissolved in the arterial plasma

Normal: 35 - 45 mm Hg

Is regulated in the lungs

A primary respiratory problem is when PaCO2 is:

> 45 mm Hg = respiratory acidosis

< 35 mm Hg = respiratory alkalosis

HCO3 will be normal (22 - 26 mEq/L)

Arterial Blood Gas Interpretation

HCO3 (bicarbonate)

Normal: 22 -26 mEq/L

Is regulated by the kidneys

A primary metabolic or renal disorder is when the HCO3

is < 22 = metabolic acidosis or

> 26 = metabolic alkalosis

PaCo2 is normal

Arterial Blood Gas Interpretation

Compensation:

body attempts to recover from primary problem and return to homeostasis

Primary metabolic acidosis can cause the patient to breathe faster to compensate
(blow off CO2) by creating a respiratory alkalosis state

This would be labeled as: Metabolic acidosis with a compensatory respiratory alkalosis

pH 7.30, PaCO2 = 28 & HCO3 = 15

Are PaCo2 & HCO3 below normal? Yes! Compensation!

Interpreting ABGs:

(A Systematic Approach)

step 1 Evaluate the pH

acidosis = < 7.35 --------------- 7.35-7.45 = normal --------------- > 7.45 = alkalosis or
compensated state

step 2 Evaluate the pCO2

resp. acidosis =if>45 ------------35-45=normal;-------------if<35= resp. alkalosis

go to HCO3

step 3 Evaluate HCO3

metab. acidosis =if<22-----------22-26=normal-----------if>26= metab. alkalosis

Note: If CO2 and HCO3 are both abnormal, look to see which one has a change that
matches the change in the pH (i.e., CO2 acts as an acid; HCO3 acts as a base). This
match will be the primary imbalance, while the other system is compensating.

How to Perform an ABG

By Francine Sanchez, eHow Member

Arterial Blood Gas Sample

User-Submitted Article

How to Perform an ABG? Arterial Blood Gas Sampling is a blood test performed
typically by a Doctor, phlebotomist, pulmonary lab technician nurse or respiratory
therapist. It involves drawing blood from the radial artery, but also less commonly from
the femoral or brachial artery.

The procedure takes about 5-10 minutes and results can be analyzed quickly.

To learn how to perform this procedure, for a class, job training or common knowledge,
continue reading.
Difficulty: Moderate

Instructions
• 1
INFORM THE PATIENT - You will begin the process by introducing yourself to
the patient. Make sure to check his/her identity either verbally or by looking at his
wrist band if he/she is unconscious.

Let him/her know that you need to take a blood sample from his/her wrist (radial
artery) and that he/she may experience slight pain such as a sharp scratch. Get
verbal consent.
 Ask if there is a preference which hand you use. If there is no preference choose
the non dominant hand.
• 2
GATHER YOUR SUPPLIES - For this procedure you will need:

Protective Glasses
Gloves
Provodine-Iodine Swab
Alcohol Swab
ABG Sampling Kit
2x2 Gauze
Bag of Ice

If you do not have an ABG kit, this consists of:

Heparinised syringe and needle (21 gauge or less)
1% lidocaine (1-2mls) and syringe
• 3
PERFORM ALAN'S TEST - Alan's test will determine whether there is collateral
circulation to the limb and if the artery is patent. If it is not patent, you will need to
try the other hand.

To perform Alan's test, palpate the radial and ulnar arteries. Ask the patient to
make a tight fist. While their hand is in a fist, put pressure on the radial and ulnar
artery and occlude the blood flow. The hand will turn white. Tell your client to
open their fist and release the ulnar artery. The hand should turn pink again. If
this happens continue to the next step. If it does not do Alan's test on the other
hand.
• 4
PREPARE THE AREA - Now you will want to clean the area around the radial
artery with the provodine-iodine swab. You will want to start at the middle and
clean out in a circular motion. Let dry and wipe away with the alcohol swab.
• 5
ANESTHETIZE THE AREA (OPTIONAL) - An optional step is to anesthetize the
area with 1-2% lidocaine. You will only need about 2mm and should form a bleb
under the skin.
• 6
PREPARE THE SYRINGE - If you do not have a abg kit, you will want to make
sure the syringe has heparin and roll the syringe in your hand so that the inside is
covered with heparin.
• 7
INSERT THE NEEDLE - You will want to palpate the artery and feel for a pulse.
The pulse is the major indicator you are drawing from the correct spot. Roll your
finger right up from the pulse when you are ready to insert the needle. Insert the
needle at a 45 degree angle making sure the bevel is up. Aim for the pulse, not
 the bone (as the bone will be painful for your patient). You will want to collect
about 3mm of blood.
• 8
REMOVE THE NEEDLE - Gently and quickly remove the needle and at the same
time put 2x2 gauze over the over the incision. Press firmly for two-five minutes.
(You may want to ask the patient to do this as well).
• 9
PREPARE THE SAMPLE FOR LAB - Next you will want to remove the air
bubbles. Remove the needle and place cap on the syringe. Dispose of needle in
appropriate place. Send the sample to the laboratory in the bag of ice. Inform the
lab about the sample.

Thank the Patient and the Examiner.

Read more: How to Perform an ABG | eHow.com

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