Student Name: …………………………………………
Date ………………
Rating Scale Point:
No.
Key
2
Completely
Done
1
Partially Done
0
Not Done
Skill #3 Title:
Performance Expectation
Acceptable performance. Consistent in logically following a taught set of rules within
a reasonable timeframe or using a reasonable alternative approach that would
probably give the same effect.
Perform with insignificant omission. Inconsistent in logically following a taught set
of rules and a reasonable timeframe
Perform with significant omission. Failure to logically follow a taught set of rules
and a reasonable timeframe. Or the student has not performed the action at all.
Breast and Lymphatic Assessment Checklist
Steps
Pre-performance
a. Nursing History Assessment
2.
Ask the patient for the following:
 Any pain or tenderness in breast?
 Any lump or thickening in breasts?
 Any discharge from nipples?
 Any rash on breasts?
 Any swelling in the breasts?
 Any trauma, injury, or radiation to breasts?
 Any history of breast disease?
 Ever had surgery on breasts?
 Ever been taught breast self- examination?
 Ever had mammography? When?
b. Prepare the Client
Introduce yourself
3.
Verify the client’s identity.
4.
Explain the procedure to the client
5.
Perform hand hygiene
6.
Provide for client privacy.
7.
Position the patient in a sitting position
1.
Performance
8.
9.
10.
Inspection
I- Inspect the breast and screen for any retraction
Lift the arms slowly over the head and note the symmetry of size
and shape.
Note the skin for any localized areas of redness, bulging or
dimpling
Note the nipple for any dry scaling, ulceration, bleeding or
discharge
Quality of Performance
Completely
Done
Partially
Done
Not
Done
2
1
0
11.
12.
13.
Push her hands onto her hips and to push her palms together; or
Ask her to place her hands on her hips and squeeze inward and
note for slight retraction.
Ask the client to lean forward while you support her forearms &
note the breast symmetry
Inspect and Palpate the Axillae in all direction
b. Palpation
14.
Assist the client to supine position
15.
Tuck a small pad under the side to be palpated and raise her
arm over her head
Use the 3 middle fingers are held together, with the metacarpalphalangeal joint slightly flexed.
Palpate the breast using:
 The vertical strip pattern,
 Spokes-on-a wheel pattern,
 Circles pattern.
Make gentle rotatory motion on the breast- small circles
Cover the entire breast in a systematic fashion, including the
tail of the breast that extends up into the axilla.
Move in a clockwise fashion
16.
17.
18.
19.
20.
c. Palpate Nipple
21.
22.
23.
24.
With your thumb and forefingers, gently depress the nipple
tissue in to the wall behind the areola
Note the color & consistency of the discharge
If you feel lump or mass, note for the following:
Location, size, shape, consistency, movable, tenderness, &
lymphadenopathy.
Teach the Breast Self-Examination
Post-performance
25.
Rearrange the equipment
26.
Documentation
Total Score:
No of items done by student
____ /52
Instructor’s Comments:
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………
Instructors Name and Signature:
_______________________________________________