NurseReview.Org - Genitalia


Published on

http://NurseReview.Org for more stuff.

Published in: Health & Medicine, Technology
1 Comment
  • Found a helpful website that I thought may help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools that already are helping me. Hope they help :-)
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

NurseReview.Org - Genitalia

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