Best way to lift a sagging breast for apical pulse

[noyesno]

I could not hear my patient's apical pulse through her breast tissue and my preceptor told me you had to lift the breast to be able to hear it. Okay, that makes sense and all but how do you go about lifting breast?

My patient was sitting in the bedside chair and her breast was sagging pretty low. The only way I could imagine elevating the breast would be through a whole hand grasp, squeeze, and lift but I thought that might make her uncomfortable.

Any other ways to get the breast up and out of the way without making the little old lady feel violated?

[netglow, ASN, RN]

Ha, canoe you remind me of one time I went to see my gyn for a regular checkup. He was still in surgery, so I saw the new guy. Weeeellll, when it came time to do the breast exam, I noticed his hand was shaking... not a little but a lot and he was hardly even touching me. Clearly, he was a bit unhinged and nervous (because of how hot I am, clearly, nuff said ) He was so young and nervous and turned beet red, and I was trying so hard not to just let out the biggest snort, ROFLMAO!!!! He was really quick about it, and then wouldn't look me in the eye. Poor guy.... he forgot the other one!!!

[I<3H2O, BSN, RN]

I always just say, "I'm gonna listen under your boob/breast." Which word I use depends on the person. LOL I just kind of shove my stethoscope under there. lol

[Ruthfarmer]

I think it's great that you are concerned with your patient's comfort and that you don't want to upset your patient. That makes you all aces in my book!

In the ER I had to do quite a few EKG's as well assessments. I generally say, "We need to get your shirt off (or unfastened.)" "Now I need to reach under your breast, if that's okay with you." Most ladies take that as a cue to lift the breast. Those who are unable to assist, at least have been advised what I'm about to do." I also talk all my patients through whatever I am doing, whether I think they can hear and understand or not. It seems most respectful and I know that is how I want to be treated.

Whenever at all possible, I try to protect my patient's modesty and prevent unnecessary exposure. I also try to be matter of fact as though I'm handling their arm or other less "personal" part of the body.

I do remember having to get past that awkward feeling when I would inadvertently touch a breast when I would be wrestling a blood pressure cuff in place on the upper arm. Unless an amply endowed lady holds her arm straight out from her side, it can be difficult to get the BP cuff in place without some contact being made with the side of the breast.

Almost every nurse has had some situation that they found awkward at some point. It's just part of learning to be a nurse and learning to work within another person's personal space. :)

[MassED, BSN, RN]

I could not hear my patient's apical pulse through her breast tissue and my preceptor told me you had to lift the breast to be able to hear it. Okay, that makes sense and all but how do you go about lifting breast?

My patient was sitting in the bedside chair and her breast was sagging pretty low. The only way I could imagine elevating the breast would be through a whole hand grasp, squeeze, and lift but I thought that might make her uncomfortable.

Any other ways to get the breast up and out of the way without making the little old lady feel violated?

:yeah::lol2:

funny. You just lift and listen. :lol2: The old lady knows she's hanging low, chances are it's not a big deal to her, so just talk while you're moving the hanging part and act like it's not a big deal.

[MassED, BSN, RN]

Just whatever you do...the nipple is not there for your convenience! Yeah, silly, I know...this thread just called to mind the physician in ICU that, instead of sternal rubs...you guess what he pinched to gauge alertness!!

no WAY.

[NurseBlueBear]

Code turtle?

:lol2: :lol2:

[General E. Speaking, RN, RN]

Reminds me of my nursing instructor that told us the story of the old country farmer that never went to the doctor. Apparently he had an inguinal hernia and eventually over many many years practically all of his intestines had slipped into his scrotal sac. Skin stretches over time so he developed ginormous testicles. His wife made "special" pants for him.

My question (of course) was "Where do you listen for bowel sounds?

[KJStarling]

Just whatever you do...the nipple is not there for your convenience! Yeah, silly, I know...this thread just called to mind the physician in ICU that, instead of sternal rubs...you guess what he pinched to gauge alertness!!

We actually did this in a unit I worked on, when the sternal rub didn't elicit a response... Imagine my surprise when the patient (male) started giggling!

Anyway, I use the back of the hand trick too.

[noyesno, MSN, APRN, NP]

I used the back of the hand maneuver two times today! It worked out well.

Thanks everyone!

[carolmaccas66, BSN, RN]

If you slip the stethoscope under the breast (the best way I think), ensure you warm up the stethoscope first. A cold steth under a nice, warm boob is no fun!

[cb_rn]

On an awkwardly related note, imagine my surprise when a more seasoned nurse than I used a large amt of tape to "hoist" a very thick panniculum (is that the right word, I call it my mini-version the jelly-roll?!?!) for a sheath pull from the groin.

... luckily the patient was snowed on propofol but it was just kind of awkward to see a roll of adipose tissue suspended mid-air for a couple of hours. I might have felt bad for not asking if it was really appropriate to do this except this was a really stressful pull and it seemed like hemostasis took forever so I'm guessing the patient would have preferred the humiliation of taping to the possibility of losing more blood since it was really difficult to manually displace the extra tissue despite the number of extra hands we had in the room.

This is my first time being involved in the sheath pulls so maybe its not as odd as I thought...however, what the heck would we have done if this patient had been alert? Using the clamp was NOT an option and as it was I thought my fingers were going to be permanently contracted.

[backatit2]

just wait til you find an old man asleep with a urinal nowhere near his member. you'll wish you were only having to lift a breast. seriously, things like that become second nature after awhile. it's pretty much daily i have to wake up an old man by saying, "you're gonna have to work on that aim!" trust me, when the option is to say something or have to change a bed bc someone poured pee all over themselves, you'll choose the awkward comment.

on another note - i missed a question when i took a test awhile back that asked where you take the apical pulse because the breast thing threw me off. the answer was below the left nipple and i selected above the left nipple because i was thinking about where i've always had doctors listen to MINE and they've never taken it under my breast, but instead pretty much where you hold your hand "over your heart" when saying the pledge, etc. maybe they were too shy to lift my breast? lol.