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
1. 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.
2. Stay relaxed and breathe normally as you do your BSE. Becoming tense will produce some knots that
you may mistake for something worrisome.
3. Report any changes or unusual pain to your doctor or nurse practitioner. Keep a log of changes, if that
helps you remember.
4. 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

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/007069.htm

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. 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. 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. 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. 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. 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. 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. 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. 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. 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 http://www.ehow.com/how_5026394_perform-

abg.html#ixzz15cIf2FK7