msc nursing

1. INSTITUTE OF NURSING AND RESEARCH CENTER SURAJPUR CG.
SUBJECT:- MEDICAL SURGICAL NURSING
ASSIGNMENT ON:- BREAST SELF EXAMINATION
SUBMITTED TO:- SUBMITTED BY:-
MADAM VANDANA DUBEY SMRITIKA SHIBA DAS
ASSISTANT PROFESSOR MSc NURSING 1st YEAR
INSTITUTE OF NURSING AND MEDICAL SURGICAL NURSING
RESEARCH CENTER SURAJPUR CG

2. INSTITUTE OF NURSING AND RESEARCH CENTER SURAJPUR CG
Name of the supervisor → Mdam Vandana Dubey
Name of the student teacher → Smritika Shiba Das
Name of the subject → Medical surgical nursing
Topic → Breast self examination
No. of student →
Class → BSc nursing Year
Date and time →
Duration → 30 min
Venue → Institute of nursing and research center surajpur cg
A.V. aids → LCD, chart, handout.
Method of teaching → Lecture, discussion .
Resources → Books, net, journals.
Previous knowledge of the student → Student had some knowledge about Breast self Examination.

3. GENERAL OBJECTIVE:-
At the end of the class teaching the student will be able to explain the Breast self examination.
SPECIFIC OBJECTIVE:-
At the end of the class the student will be able to-
1. give introduction of breast self examination.
2. define the breast self examination
3. explain the purpose of breast self examination.
4. discuss about the timing of BSE.
5. explain the pattern of breast self examination.
6. discuss the physical assesment finding healthy adult.
7. explain the steps in breast self examination.
8. discuss the component of BSE.
9. discuss the indication of BSF.
10. enlist the precautions for BSE.
11. discuss the role of nurse in BSE.
12. explain the findings of BSE.
13. enlist the sign of breast cancer.

4. SPECIFIC
OBJECTIVE
TIME CONTENT TEACHING
LEARNING
ACTIVITY
AV
AIDS
EVALUATION
To give
introduction of
breast self
examination.
To define the
breast self
examination
Explain the
purpose of
breast self
examination.
To discuss
about the
timing of BSE.
Explain the
pattern of
breast self
examination.
2 min
1 min
2 min
2 min
3 min
Introduction :- A breast self examination is a technique which allows an individual to
examine his/her breast tissue for any physical or visual changes. • It is often used as an early
detection method for breast cancer. • Both men and women should perform a BSE at least once
each month beginning at age 20. • A breast self-exam is a way anyone can check own breasts for
any changes such as lumps or thickenings that could be symptomatic of breast cancer. • This
process includes looking and feeling each breast, and reporting anything unusual to the doctor.•
When breast cancer is detected in its early stages, chances of surviving the disease are greatly
improved. • In fact, women who perform regular breast self exam find 90% of all breast masses.
Definition:- • A procedure in which women examine her breasts and their accessory
structure for evidence of change that could indicate a benign or malignant process.
Purposes:-
➢ • To find any changes that may occur.
➢• To detect breast lumps.
➢• To improve quality of life.
➢ • To cost benefit.
Timing of BSE:-
➢• Beginning at the age of 20years or after onset of menarche.
➢ • The BSE is usually performed within 7-10 days after the first day of the menstrual cycle,
when the breasts are smallest and cyclic nodularity is least apparent.
➢ • If her periods arenot regular, a BSE should be done on the same day every month.
➢ • BSE should be regularly performed by every woman such as pregnant, breast feeding and
menopausal woman, or have breast implants.
Pattern for BSF:-
• Circling, massaging motion and follow a clock pattern or wedge pattern or sweeping motion
( outer part to towards nipple).
There are 3 pattern of breast self examination.
Lecture
Explanation
Lecture
Explanation
Discussion
Discussion
Lecture student
by active
listening
Flash
card
chart
chart
What is breast
self
examination.?
Define breast
self
examination?
what is the
purpose of breast
self
examination.?
what is the best
timing for breast
self
examination.?
Explain the
pattern of breast
self
examination.?

5. SPECIFIC
OBJECTIVE
TIME CONTENT TEACHING
LEARNING
ACTIVITY
AV
AIDS
EVALUATION
1) CLOCK PATTERN:-
• Visualize breast as face of clock, place left hand behind head and examine left breast with right
hand.
• Place right hand at 12 ‘o’ clock at very top of breast.
• Place pads of three middle fingers firmly on breast in slight circling massaging motion.
• Move hands down to 1 ‘o’ clock , then2 ’o’ clock and so on until return to 12 ‘o’ clock .
• Continue same pattern, moving hand in smaller circles toward nipple.
• Place right hand behind on head and repeat examination on right breast.
• Check for tissue under nipple and look for discharges.
• Check tissues under armpit and surrounding breast.
2) WEDGE PATTERN:-
• Visualize breast as a circle divided into wedges like piece of pie.
• Place left hand behind head and examine left breast by right hand
• Press pads of three middle finger pads firmly in slight circling and massaging motion.
• Start at the top of breast about half inch below collarbone and slide fingers in toward nipple.
• Examine breast tissue in entire wedge. Move finger clock wise to next wedges, until complete
breast and armpit.
• Place right hand behind head and repeat procedure for right breast with left hand.
3) SWEEPING PATTERN: • Place left hand behind head and examine left breast with right
hand.
• Instead of circling, massaging motion, sweep three middle fingers from collarbone to nipple.
• Clockwise around breast, sweep fingers outside to inside toward nipple.
• To feel deeper breast tissue repeat process using walking motion with fingers.
• Place right hand behind head and examine right breast using left hand.

6. SPECIFIC
OBJECTIVE
TIME CONTENT TEACHING
LEARNING
ACTIVITY
AV
AIDS
EVALUATION
Discuss the
physical
assesment
finding healthy
adult.
Explain the
steps in breast
self
examination.
Discuss the
component of
BSE.
2 min
3 min
5 min
PHYSICALASSESSMENT FINDING IN HEALTHY ADULT
1) BY INSPECTION: Breast should be- • Symmetrical, full, rounded, smooth in all portions,
without dumping, retraction, masses.
• Nipple everted, areola even
• Axilla even, color normal, without masses or rash.
2) BY PALPATION: • Firm without masses and lumps. • No discharges • Smooth axilla.
STEPS IN BREAST SELF EXAMINATION • Inspection on mirror • Palpation (Lying
position) • Palpation ( Standing or sitting position)
1.INSPECTION ON MIRROR • Stand and face mirror with arms relaxed at sides or arms
resting on hips; then turn to right and left for side view look. • Bend forward form waist. • Stand
straight with arms raised over head and move arms slowly up and down at sides.( Look for free
movement of breast over chest wall)
2.SITTING OR STANDING POSITION- • Examine using clock pattern, or wedge pattern or
sweeping technique. • Do upright BSE in shower , soapy hands glide more easily over wet area.
3.PALPATION- LYING POSITION: • To examine left breast, Place pillow under right
shoulder and place right hand behind head . This position evenly distribute breast tissues. •
Examine in clock pattern, check for abnormalities. Repeat procedure for right breast.
COMPONENT:- 1. Position • One important component during breast examination is
position. • Depending on whether looking at or feeling the breast, women should select different
options.• Use of mirror and a proper light system facilitate detection of abnormalities. • BSE can
be done either in the sitting or lying down position (dusting the hand with powder or using
cream).
2. Hand movements • Use the pads of three middle fingers to examine every inch of breast
tissue. • Move fingers in small circular and regular movement to cover the entire breast, part by
part. • Donot lift the fingers from breast between palpations.
Discussion
Lecture
Explanation
Demonstration
students active
listening and
writing notes.
Explanation
Demonstration
students active
listening and
writing notes.
-
chart
chart
What is normal
finding in
healthy adult .?
what is the steps
of breast self
examination.?
what is the
component of
breast self
examination.?

7. SPECIFIC
OBJECTIVE
TIME CONTENT TEACHING
LEARNING
ACTIVITY
AV
AIDS
EVALUATION
• Use powder, lotion or soap to help fingers glide from one spot to the next. • If any difficulty
using or feeling with the finger pads of one of both hands, try using the thumb, the palm of hand.
3. Palpation perimeter • The examination area is bound by the line which extends down
from the middle of the armpit to just beneath the breast, continues across the underside of the
breast to the middle of the breast bone, then moves up and along the collar bone and back to the
middle of the armpit.
• Most breast cancers occur in the upper outer area of the breast.
4. Pressure level • For each small circle, change the amount of pressure, so one can feel the
different levels of breast tissue. • Light pressure to feel the tissue closest to the skin.• Make each
small circle three times: once light, once medium and once deep-before moving on the next area.
• Firm pressure to feel the tissue closet to the chest and ribs. A firm ridge in the lower curve of
each breast is normal
5.Breast palpation • Be sure to palpate carefully beneath the nipple. • Women who have had
any breast surgery should still examine the entire area and the scar. • Any scar should also be
carefully examined from end to end.
a. Wedge method • Start in the armpit, proceed downward to the lower boundary. • Move a
fingers width toward the middle and continues palpating at upward until to the collarbone. •
Repeat until all the breast tissue are covered. Make atleast 6 strokes before the nipple and 4
strokes after the nipple. • One may need between 10 and 16 stroked to cover all the breast tissue.
b. Circular form • Think of the breast as a force on a clock, • Start at 12’o clock and move
toward 1o’clock in small circular motions. • Continue around the entire circle until reach 12
o’clock again. • Keep fingers flat and in constant contact with breast.
c. Breast palpation in triangle pattern. • Palpation is begun at the medial portion of the
chest wall below the clavicle and progresses down and up in a vertical strips pattern.
• The examiner should slide from palpation position to examiner should slide from palpation
position to position rather than lifting his or her hand.

8. SPECIFIC
OBJECTIVE
TIME CONTENT TEACHING
LEARNING
ACTIVITY
AV
AIDS
EVALUATION
Discuss the
indication of
BSF.
Enlist the
precautions for
BSE.
1 min
3 min
6.Axillary examination • Examination of the armpits. The arm should be lower because
when the hand is behind head, the axillary skin is tight and difficult to palpate.
• Gently move the arm 20-30 cm away, so can gain access to axillary region. • Direct the fingers
tips of examining hand toward the top of axilla. Then push the palmar aspect of hand towards
chest wall.
7. Check for nipple discharge on nipple • Squeeze nipples to check for discharge. •
Many women have a normal discharge. • Nipple discharge can also be a sign of breast problem. •
Look for discharge in bra or clothing. • Report any discharge to physician.
Indications of BSE 1. Complaints of breast pain 2. Skin changes 3. Nipple discharge4Lumps
5. Gross changes in size or shape 6. Breast lump developing during pregnancy or lactation
Precautions for BSE• When examining the breast, some general tips to keep in mind
include: .
1. Use the pads of fingers: • Use of the pads, not the very tips of three middle fingers for exam.
• If any difficulty feeling with finger pads, use another part of hand that is more sensitive, such
as palm or the backs of the fingers.
2. Use different pressure levels: • The goal is to feel different depths of breast by using
different levels of pressure to feel all the breast tissue. • Use light pressure to feel the tissue
closet to the skin, medium pressure to feel a little deeper, and firm pressure to feel the tissue
closet to the chest and ribs.
• Be sure to use each pressure level before moving onto the next spot. • If not sure how hard to
press, talk with doctor or nurse.
3. Take time: • Donot rush. • It may take several minutes to carefully examine breasts.
4. Follow a pattern: • Use a methodical technique to ensure the examination of entire breast. •
For instance, imagine the face of a clock over the breast. • Begin near collarbone and examine
that section, moving finger toward nipple.
Contraindications • If a woman is excessively anxious about the breast examination. • Prior
history of venous thrombosis.
Explanation
Demonstration
students active
listening and
writing notes.
-
flash
card
What is the
indication of
breast self
examination.?
What are the
precautions use
for the breast self
examination.?

9. SPECIFIC
OBJECTIVE
TIME CONTENT TEACHING
LEARNING
ACTIVITY
AV
AIDS
EVALUATION
Discuss the
role of nurse in
BSE.
Explain the
findings of
BSE.
Enlist the sign
of breast
cancer.
2 min
2min
2 min
Disadvantages:- 1. Fear and anxiety about what may be found during the exam.
2. False-positive (False alarm) finding, which is a result that indicates that a condition is present
(i.e. breast lump or possible cancer) when it is not (i.e. non-cancerous breast tissue)
Role of Nurse in BSE :-
• Assessing a patient’s compliance of performing self-breast examinations should entail not only
if she merely does the examination, but when she is doing them and how she is doing them.
• As the primary nurse, if we are not educated on proper techniques of a self-breast examination,
it is our responsibility to provide a resource to the patient that can properly demonstrate this.
• Women should be educated on the proper way to do a self-breast examination.
• Women should be told about the ideal time of month to perform examination. This will allow
women to know what is normal breast tissue and what is abnormal to aide in early detection of
breast cancer.
Findings: • Redness of skin on breast or nipple.
• Bloody or clear fluids discharge from nipples.
• Changes in feeling or appearance of skin on nipple or breast like dimples, scaly ,inflammed.
• Marbal like area under skin.
• Mass or lump feel as small as pea.
• Change in size, shape, contour of breast.
• Normal breasts and nipples.
Sign of breast cancer:-
1. • Elevation
2.• Asymmetry
3. • Bleeding
4.• Orange peel skin
5. • Nipple retraction
6. • Discharges
Explanation
Lecture
students active
listening and
writing notes.
Lecture
Explanation
-
chart
-
What is the role
of staff nurse in
breast self
examination.?
What are the
findings of breast
self
examination.?
What are the
sign of breast
cancer.?

10. BIBLIOGRAPHY:-
Book References :-1.Prasai S. Durga. Gynaecology Nursing. 2nd Edition. Jamal,kathmandu: Medhavi Publication; 2018:105-110
2.Brunner and Suddarth’s. Textbook of Medical- Surgical Nursing. 13th edition. New Delhi: Wolters Kluwer;2016:359-373
3• Sharma Sarojini. Oncology Nursing Manual. 4th Edition. Bharatpur, Chitwan:BP Koirala Memorial Cancer Hospital, Dec 2014: 15-
Net References:- 1• Henderson JA, Ferquson T. Breast Examination Techniques. Available from (https://www.ncbi.nlm.nih.gov/books/NBK459179)
. Accessed Date: 30th Edition, 2019
2•Myoclinic. Breast Self examination for breast awareness. Available from (https://www.mayoclinic.org/tests.procedure/breastexa
minationabout/pac.20393237) Accessed Date: 30th Nov 2019 • Breast 360.
3. Breast Self Examination. Available from (https://Breast360.org/topics/2015/02/03/BreastSelfExa mination_bsel) Accessed Date : 30th Nov
2019