Female genitourinary

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  • 1. Female Genitourinary System
  • 2. Structure and Function External Genitalia or Vulva
  • 3. External Genitalia or Vulva Mons Pubis –is the flat pad located over the symphysis pubis. -functions to absorb force and to protect the symphysis pubis during coitus.
  • 4.  Labia Majora – The main function of the labia majora along with the coarse hairs on it is to keep away germs and bacteria from entering the inner parts of the vagina and the urethra.  Labia minora – labia minora close together, protecting their inner mucous membrane and closing off the vaginal entrance.  Frenulum - is a small fold of tissue that secures or restricts the motion of a mobile organ in the body.
  • 5.  Clitoris –The clitoris is the center of sexual sensation in women.  Urethral meatus –Urethra meatus is the transport tube leading from the bladder to which brings urine outside the body. It is shorter in female than in the male. The opening of the female urethra is beneath the vaginal opening.
  • 6.  Paraurethral (Skene’s) glands - are glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening and may be near or a part of the G-spot.  Hymen -it tends to keep germs and dirt out of the vagina. In infants and children, the hymen can serve a protective purpose by helping to prevent things from being pushed into the vagina
  • 7.  Vestibular (Bartholin’s) glands -They secrete mucus to provide vaginal lubrication. And secrete relatively minute amounts (one or two drops) of fluid when a woman is sexually aroused.
  • 8. Function of Internal Genitalia  Vagina -this passage leads from the opening of the vulva to the uterus (womb), but the vaginal tract ends at the cervix  Cervix -The function of the cervix is to allow flow of menstrual blood from the uterus into the vagina, and direct the sperms into the uterus during intercourse.
  • 9.  Anterior fornix and posterior fornix -Stimulation of the fornices has been reported to enhance sexual pleasure for some women.  Rectouterine pouch or cul-de-sac of Douglas –Can serve as a drainage point for fluids in the cavity.  Uterus –A uterus is the place that a fetus develops. Uterus also supplies antibodies to protect the young one from infectious diseases,  Fallopian tubes - The fallopian tubes connect the ovaries to the uterus.
  • 10. Objective data: Physical ExaminationThe physical examination of the female genitalia may create client anxiety. The client may be very embarrassed about exposing her genitalia and nervous that an infection or disorder will be discovered. Be sure to explain in detail what you will be doing throughout the examination. Encourage the client to ask questions. Begin by sitting on a stool at the end of
  • 11. Preparing the client • The client should be told ahead of time not to douche for 48 hours before a gynecologic examination. • When the client arrives for the examination, ask her to urinate before the examination so she does not experience bladder discomfort. • When the client is back in the examination room ask her to remove her underwear and bra and to put on a gown with the opening in the back. • After the client has changed and the nurse has returned to the room, the nurse should help the patient into the dorsal lithotomy position. • The client’s hip should be positioned toward the bottom of the examination table. • Ask the client to put her hands over her head. • She should relax her hands at her sides.
  • 12. Physical Assessment: External Genitalia Normal Findings Inspection: Inspect the Mons Pubis. Wash your hands and put on gloves. As you begin the examination note the distribution of the pubic hair. Also be alert of the signs of infestation. -pubic hair is distributed in an inverted triangular pattern and there are no signs of infestation. -Older clients may have gray, thinning pubic hair. -Some clients shave or pluck the pubic hair. Piercing of the mons pubis are for aesthetics and do not enhance sexual pleasure. -Absence of pubic hair in the adult client is abnormal. -Lice or nits(eggs) at the base of the pubic hairs indicate manifestation with pediculosis pubis. This condition, commonly reffered to as “crabs”, is most often transmitted by sexual contact. Observe and palpate inguinal lymph nodes. There should be no enlargement or swelling in the lymph nodes. -Enlarged inguinal nodes may indicate a vaginal infection or may be the result of irritation fromshaving pubic hairs. Abnormal Findings
  • 13. Normal Findings Inspect the Labia majora and perineum. Observe the labia majora and perineum for lesions, swelling, excoriatio n. -The Labia majora are equal in size and free of lesions, swelling, and excoriation. A healed tear or episiotomy scar may be visibleon the perineum if the clienthas given birth. The perineum should be smooth. -Lesions may be from an infectious disease such as serps or syphilis. Excoriation and swelling may be from scratching or self-treatment of the lesions. All lesions must be evaluated and the client referred for treatment. Inspect the labia minora, clitoris, urethral meatus, and vaginal opening. Use your gloved hand to separate the labia majora and inspect for lesions, excoriation, swelling and/or discharge. -The labia minora appear symmetric, dark pink, and moist. The clitoris is a small mound or erectile tissue, sensitive of touch. The normal size of the clitoris varies. The urethral meatus is small and slitlike. The vaginal opening is positioned belowthe urethral meatus. Its siz depends on sexual activity or vaginal delivery; may be covered partially or completely by hymen. -Asymmetric labia may indicate abscess. Lesions, swelling, bulging in the vaginal opening, and discharge are abnormal findings. Excoriation may result from the client scratching or self-treating a perineal irritation. Abnormal Findings
  • 14. Normal Findings Palpation: Palpate Bartholin’s glands. If the client has labial swelling or a history of it, palpate Bartholin’s glands for swelling, tenderness and discharge. Place your index finger in the vaginal opening and your thumb on the labia majora. With a gentle pinching motion, palpate from the inferior portion of theposterior labia majora to the anterior portion. Repeat on the opposite side. -Bartholin’s glands are usually soft, non tender, and drainage free. -Swelling, pain and discharge may result from infection and abscess. If you detect a discharge, obtain a specimen to send to the laboratory for culture. Palpate the urethra. if the client repots urethral symptoms of urethritis, or if you suspect inflammation of Skene’s glands, insert your gloved index finger into the superior portion of the vagina and milk the urthra from the inside, punshing up and out. -No drainage should be noted from the urethral meatus. The area is normally soft and non- tender. -Drainage from the urethra indicates possible urethritis. Any discharge should be cultured. Urethritis may occur with infection with Neisseria gonorrhoeae or Chlamudia trachomatis. Abnormal Findings
  • 15. Physical Assessment: Internal Genitalia Normal Findings Inspection: Inspect the size of the vaginal opening and the angle of the vagina. Insert your gloved index finger into the vagina, noting the size of the opening. Then attempt to touch the cervix. This will help you establish the size of the speculum you need to use for the examination and the angle at which to insert it. - The normal vaginal opening varies in size according to the client’s age, sexual history and whether she has given birth vaginally. The vagina is typically tilted posteriorly at a 45-degree angle. - Cervical enlargement or projection into the vagina more than 3cm may be from prolapse or tumor, and further evaluation is needed. Inspect the vagina. Unlock the speculum and slowly rotate and remove it. Inspect the vagina as you remove the speculum. Note the vaginal color, surface, consistency, and any discharge. -The vagina should appear pink, moist, smooth and free of lesions and irritation. It should also be free of any colored malodorous discharge. -Reddened areas, lesions, and colored, malodorous discharge are abnormal and may indicate vaginal infections. STD’s or cancer. Abnormal Findings
  • 16. Normal Findings Inspect the vaginal musculature. Keep your index finger inserted in the client’s vaginal opening. Ask the client to squeeze around your finger. Use your middle and index fingers to separate the labia minora. Ask the client to bear down. -the client should be able to squeeze around the examiner’s finger. Typically, the nulliparous woman can squeeze tighter thann the multiparous woman. No bulging and no urinary discharge. -absent or decreased ability to squeeze the examiner’s finger indicates decreased muscle tone. Decreased tone may decrease sexual satisfaction. Bulging of the anterior wall may indicate a cystocele. Bulging of the posterior wall may indicate rectocele. If the cervix or uterus protrudes down, the client may have uterine collapse. If urine leaks out, the client may have stress incontinence. Inspect the cervix. Follow the guidelines for using a speculum in equipment. With the speculum inserted in position to visualize the cervix, observe cervical color, size, and position. -the surface of the cervix is normally smooth, pink and even. Normally, it is midline position and projects 1 to 3cm into the vagina. In a pregnant woman, a bluish cervix may indicate cyanosis. In a non menopausal woman, a pale cervix may indicate anemia. Redness may be from inflammation. Abnormal Findings
  • 17. Normal Findings Palpation: Palpate the vaginal wall. Tell the client that you are going to do a manual examination and explain its purpose. Apply water soluble lubricant to the gloved index and middle fingers of your dominant hand. Then stand and approach the client at the correct at the correct angle. Placing your nondominant hand on the client’s lower abdomen, insert your index and middle fingers into the vaginal opening. Apply pressure to the posterior wall and wait for the vaginal wall to relax before palpating the vaginal walls. -the vaginal wall should feel smooth and the client should not report any tenderness. -tenderness or lesions may indicate infection. Palpate the cervix. Advance your fingers until they touch the cervix and run fingers around the circumference. Palpate for: contour, mobility, consistency, tenderness. -The cervix should feel firm and soft. It is rounded, and can be moved somewhat from side to side without eliciting tenderness. A hard immobile cervix may indicate cancer. Pain with movement of the cervix may indicate infection. Abnormal Findings
  • 18. Normal Findings Palpate the ovaries. Slide your intravaginal fingers toward the left ovary in the left lateral fornix and place your abdominal hand on the left lower abdominal quadrant. Press your abdominal hand toward your intravaginal fingers and attempt to palpate the ovary. -Ovaries are approximately 3x2x1cm and almond shape. -Enlarged size, masses, immobility and extreme tenderness are abnormal and should be evaluated. Abnormal Findings
  • 19. Health Problems of Genitourinary System  Amenorrhea –is an abnormal absence of menstruation. -There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea is when a young woman has not had her first period by the age of 16. Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period for three or more months.  Anuria -Failure of the kidneys to produce urine. Caused by failure in the function of kidneys. It may also occur because of some severe obstruction like kidney stones or tumors.
  • 20.  Bacteriuria -The presence of bacteria in the urine. This is typically an indication of a urinary tract infection  Calculus/Calculi- A stone in the kidney (or lower down in the urinary tract). Also called a kidney stone.  Cryosurgery -Connective tissue separates the pelvic organs. The tissue, called fascia, is attached to nearby muscles. When healthy, the fascia and muscles support the bladder, vagina and rectum. Defects in the fascia can cause cystoceles and rectoceles.
  • 21.  Dysuria -Painful or difficult urination.  Hematuria -The presence of blood in urine.  Hyperplasia - is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus.  Menorrhagia -Abnormally heavy bleeding at menstruation
  • 22.  Metrorrhagia -Abnormal bleeding from the uterus.  Nephrolithiasis -the presence of kidney stones (calculi) in the kidney.  Nocturia -excessive urination at night.  Oligomenorrhea -abnormally light or infrequent menstruation
  • 23.  Oliguria -The production of abnormally small amounts of urine.  Ovarian cyst -a cystic tumor (usually benign) of the ovary.  Polyuria -Production of too much dilute urine.  Pyuria -The presence of pus in the urine, typically from bacterial infection.
  • 24.  Retrograde menstruation -The backward flow of menstrual blood up into the fallopian tubes, thought to be a cause of endometriosis.  Retroversion/retroflexion -is a uterus that is tilted backwards instead of forwards.  Toxic Shock Syndrome (TSS) -Acute septicemia in women, typically caused by bacterial infection from a retained tampon
  • 25.  Urolithiasis -The formation of stony concretions in the bladder or urinary tract.  Uterine prolapse - Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.  Vesicoureteral reflux -is an abnormal movement of urine from the bladder into ureter or kidneys.
  • 26. • Abscess of the Bartholin’s gland- a painful condition and common sign of Neisseria gonorrhoeae infection.
  • 27. • Syphilitic Chancre-often most appear on the perianal area as silvery white papules that become superficial red ulcers. Syphilitic chancr are painless. They are sexually transmitted and usually develop at the site of initial contact with the infecting organism.
  • 28. • Genital Herpes Simples- The initial outbreak of herpes may have many small, painful ulcers with erythematous base. Recurrent herpes lesions are usually not as extensive.
  • 29. • Rectocele- is bulging in the posterior vaginal wall caused by weakening of the pelvic musculature. Part of the rectum covered by the vaginal mucosa protrudes into the vagina.
  • 30. • Cystocele- is a bulging in the anterior vaginal wall caused by the thickening of the pelvic musculature. As a result, the bladder caused by vaginal mucosa, prolapses into the vagina.
  • 31. • Uterine Prolapse- tis occurs when the uterus protrudes into the vagina. It is graded according to how far it protrudes into the vagina.
  • 32. • Cervical Polyp- A polyp typically develops in the endocervical canal and may protrude visibly at the cervical os. It is soft, red and rather fragile. Cervical polyps are benign.
  • 33. • Trichomoniasis- this type of vaginal infection is caused by a protozoan organism and is usually sexually transmitted. This infection causes itching and urinary frequency in the client.
  • 34. Post test
  • 35. 1. Hymen is the external genitalia that tends to keep germs and dirt out of the vagina.
  • 36. 2. Rectocele is the bulging in the posterior vaginal wall caused by weakening of the pelvic musculature.
  • 37. 3. The clitoris is the center of sexual sensation in men.
  • 38. 4. Vagina leads from the opening of the vulva to the uterus.
  • 39. 5. The client should be told ahead of time not to douche for 48 hours before a gynecologic examination.
  • 40. 6. Fallopian tubes connect the ovaries to the uterus.
  • 41. 7. Absence of pubic hair in the adult client is normal
  • 42. 8. During the inspection of the inguinal lymph node there should be no enlargement or swelling.
  • 43. 9. Swelling, pain and discharge may result from infection and abscess In palpating the Bartholin’s gland.
  • 44. 10. Vestibular glands secrete mucus to provide vaginal lubrication.