Genitalia - Faculty Web Pages

Report
Genitalia
Male Genitalia
Clinical Objectives
1.
2.
3.
4.
Demonstrate knowledge of the S&S
related to the male genitalia by
obtaining a pertinent health history.
Inspect and palpate the penis and
scrotum
Teach TSE
Record the history and PE accurately,
assess, develop a plan of care.
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How does a nurse create an
environment that will be conducive for
examination?
Subjective Data for
Male
Privacy
 Reason for seeking care? Problem
usually identified as “Personal” (not a
diagnostic statement)
 How do you gather information?

Did you identify all these
areas?
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Frequency, urgency, nocturia
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Polyuria
Oliguria (< 400mls/24yrs)
Dysuria
Hesitancy and straining
Urine color
Past genitourinary history
Penis
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Pain, lesion, discharge, bleeding
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Scrotum
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TSE
Sexual Activity and contraceptive use
 STD contact
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After the client history in nonurgent
cases …..What next?
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Remember you are doing Physical
Assessment
Male Genitalia
Inspect and Palpate
Wash Hands before and after examination
 Wear Gloves
 Discharge
 If a scrotal mass is suspected, what will you
check for ?
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Pain
Location
Reduce
Auscultate
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Transillumination - performed if scrotol
swelling or mass. Darken room. Shine
flashlight from behind the sac.
Normal contents do not transilluminate
 Serous fld does = red glow (hydrccele,
spermatocele)
 Solid tissue and bld do not transilluminate
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Normal Scrotal Findings
Contents should slide easily
 Testes feel oval, firm, rubbery, smooth,
= bilaterally
 Freely movable,
 Slightly tender to moderate pressure
 Left testicle lower than right
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Inguinal Region
Bear down (should be no change)
 Cough no longer accepted practice . Why?
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need steady , increased intra abdominal
pressure.
 Likely to cough in your face
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TSE
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T = timing
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S = shower
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E = examine
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TSE Should be practiced from 13yrs on every
month.
Testicular cancer is the most common cancer
in young men age 15 to 35.
Testicular tumor has no early symptoms
Early detection by palpation and Rx = almost
100% cure
Prothesis
PQRST (U)
P: provocative or palliative
 Q: Quality or Quantity
 R: Region or Radiation
 S: Severity Scale.
 T: Timing
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“U” is Holistically important
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Understand Patient’s Perception ask
“What do you think it means?”
Documentation
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If all is well this is what you write:
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No Lesions, inflammation, or d/c from
penis. Scrotum, testes descended,
symmetric, no masses. No inguinal hernia.
Anus, Rectum, and
Prostate
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Standards for Family Practice expect
this examination to be combined with
the examination of the male and female
genitalia.
Clinical Objectives
1.
2.
3.
4.
Demonstrates knowledge of the S&S
related to the rectal area/ health
history
Inspect and palpate the perianal
region
Test stool specimen for occult blood
Document
Health History
Bowel Routine
 Changes
 Black/bloody stool
 Medications
 Rectal itching, pain, hemorrhoids
 Family history of colon/rectal polyps or
cancer
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Physical
examination
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Position
Female ? Having a PAP also
 Male
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Gloves
 Lubricating Jelly
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Perianal area
Skin condition
 Sacrococcygeal area
 Valsalva maneuver
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Palpate Anus and Rectum
Anal sphincter
 Anal Canal
 Rectal Wall
 Prostate Gland
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Size, shape, surface, consistency, mobility,
tenderness
Cervix
Examination of Stool
Visual
 Occult Blood – ( a false + may occur if
the person has ingested significant
amts. Of red meat in the last 3 days.
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Documentation
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No fissure, hemorrhoids, fistula, or skin
lesions in the perianal area. Sphincter
tone good, no prolapse. Rectal walls
smooth, no masses, tenderness. Stool
brown, hematest neg. ( no prostate
enlargement , no masses, no
tenderness)
Concerns
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Carcinoma
A rectal malignant neoplasm is
asymptomatic.
 Irregular cauliflower shape, fixed, stone
hard
 About ½ of rectal lesions are malignant
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Abnormalities of Prostate Gland
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BPH – Benign Prostatic Hypertrophy
Symptoms - urinary
 Symmetric, nontender enlargement
 Prostate surface feels smooth, rubbery, or
firm with the median sulcus obliterated
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Prostatitis
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Symptoms – infection, urinary, perineal and rectal
pain
Tender enlargement with acute inflammation
Swollen, asymmetric gland, tender to palpation
Chronic inflammation = tender enlargement,
boggy feel or firm isolated areas or normal feel.
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Carcinoma
Symptoms = urinary, continuous pain
lower back, pelvis, thighs
 Often starts as a single hard nodule
posterior surface ; asymmetrical feel and
change in consistency. Progression =
multiple hard nodules until gland is stone
hard and fixed
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Female Genitalia
Clinical Objectives
1.
2.
3.
4.
Demonstrate knowledge of the S & S
related to the female genitalia by obtaining
health history
Demonstrate knowledge of infection control
precautions before, during and after the
examination.
Inspect and palpate the external genitalia
Documentation
Health History
LMP
 Pregnancies
 Periods/ menopause
 Pap test
 Urinary symptoms
 Vaginal discharge
 Genital sores / lesions
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Sexual relationships
 Birth control
 STDs/ precautions
 Medications
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hormones
Physical
Examination
Privacy
 Position
 Comfort measures
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Empty bladder
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Wash hands in warm water
Communication
 Chaperone
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Inspect External
Genitalia
Gloves
 Assess pubic hair
 Spread labia to visualize urinary meatus
 Note discharge; ulcerations
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Palpate external genitalia
Skene’s glands
 Bartholin’s glands
 Perineum
 Assess perineal muscle strength
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Nulliparous vs multiparous
Vaginal bulging/ urinary incontinence
 discharge
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Bimanual Examination
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Obstetric Hand position intravaginal other
hand on the abdomen
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Vaginal Wall - smooth
Cervix –
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Consistency = tip of nose
Contour = evenly rounded
Movable side to side , no pain
Uterus
Adnexa – ovaries, fallopian tubes (often not
palpable)
Rectovaginal – change gloves
Documentation
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External genitalia – no swelling, lesions,
or discharge. No urethral swelling or
discharge. Internal – vaginal walls have
no bulging or lesions. Bimanual – no
pain, ovaries not enlarged. Rectal- no
hemorrhoids, fissures or lesions, no
masses, no tenderness. Stool brown,
neg. occult blood.
Abnormalities
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External Genitalia
Pediculosis Pubis (crab lice)
 Genital Warts
 Bartholin Cyst
 Cystocele – bladder prolapse into vagina
 Uterine prolapse
 Rectocele – prolapse into vagina
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Cervical Carcinoma
Abnormal bleeding
 Pap and biopsy
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Risk factors
Intercourse at early age
 + sex partners
 Smoking
 STDs
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Adnexal Enlargement
PID
 Ectopic Pregnancy
 Ovarian Cyst
 Ovarian Cancer
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Usually asymptomatic.
 Abd. enlargement from fld.
 Malignancy = heavy, solid, fixed, poorly
defined mass
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