Advanced EMS Assessment - Reproductive System

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EMS 207 class materials for advanced assessment - reproductive. The focus is on core complaints of patients

EMS 207 class materials for advanced assessment - reproductive. The focus is on core complaints of patients

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  • 1. HEALTH & PHYSICAL ASSESSMENT Assessment of the Reproductive System of Male and Female Illness and Injury NVCC EMS 207 Presented by Edward A Stern, RN
  • 2. GROSS ANATOMY OF THE MALE REPRODUCTIVE ORGANS
  • 3. STRUCTURE OF THE PENIS
  • 4. EXTERNAL STRUCTURE - SCROTUM
  • 5. MALE REPRODUCTIVE SYSTEM - INTERNAL
    • Testes
    • Spermatic cord
    • Duct system
    • Urethra
    • Accessory glands
  • 6. MALE REPRODUCTIVE SYSTEM - INTERNAL
    • Duct System
      • Epididymis
      • Ductus deferens
      • Urethra
  • 7. MALE ACCESSORY GLANDS
    • Seminal vesicles
    • Prostate gland
    • Bulbourethral gland
  • 8. FEMALE REPRODUCTIVE SYSTEM
    • Cyclical changes
    • Ovarian cycle
    • Menstrual cycle
  • 9. FEMALE REPRODUCTIVE SYSTEM
    • Manufactures ova for fertilization
    • Transports fertilized ova for implantation
    • Regulates production and secretion of hormones
    • Provides sexual stimulation and pleasure
  • 10. FEMALE EXTERNAL GENITALIA
      • Mons pubis
      • Labia
      • Glands
        • Skene ’ s
        • Bartholin ’ s
      • Clitoris
      • Perianal area
  • 11. FEMALE - INTERNAL REPRODUCTIVE ORGANS
    • Vagina
    • Uterus
    • Cervix
    • Fallopian tubes
    • Ovaries
  • 12. FIGURE 22.2A INTERNAL ORGANS OF THE FEMALE REPRODUCTIVE SYSTEM WITHIN THE PELVIS.
  • 13. FIGURE 22.2B CROSS-SECTION OF THE ANTERIOR VIEW OF THE FEMALE PELVIS.
  • 14. TRAUMA ASSESSMENT
  • 15. TRAUMA TO THE MALE GENITALIA
    • Surface Trauma
      • Zipper
      • Piercing
    • Impact
    • Avulsion
    • Assault
    • Intentional act
    • Fluid Retention
    • Hernia (Scrotal)
  • 16. TRAUMA TO THE FEMALE GENITALIA
    • Surface Trauma
      • Zipper
      • Piercing
    • Child Birth
    • Impact
    • Avulsion
    • Assault
    • Fluid Retention
  • 17. BODY PIERCING
    • Primary source of injury
    • Secondary source of injury
    • Source of infection
    • Complications with diagnostics
  • 18. HPV – WARTS
    • Genital human papillomavirus (HPV) is a common virus.
    • Most sexually active people in the United States (U.S.) will have HPV at some time in their lives. There are more than 40 types of HPV that are passed on through sexual contact.
    • These types can infect the genital areas of men, including the skin on and around the penis or anus and in woman the vagina and anus. They can also infect the mouth and throat.
    • About 1% of sexually active people in the U.S. have genital warts at any one time.
    • Each year in the U.S. there are about:
      • 800 men who get HPV-related penile cancer
      • 12,000 women get cervical cancer
      • 1100 men and 2,700 women get HPV-related anal cancer
      • 3,700 women get vulvar cancer
      • 1,000 get vaginal cancer
      • 9,000 men and 2,300 women get HPV-related head and neck cancers. [Note: although HPV is associated with some of head and neck cancers, most of these cancers are related to smoking and heavy drinking.]
    • No Diagnostic or obvious symptoms (other than the wart’s themselves)
  • 19. HPV VACCINE
    • Vaccines can protect males and females against some of the most common types of HPV.
      • These vaccines are given in three shots. It is important to get all three doses to get the best protection.
      • The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV.
    • Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls as young as 9 years of age. It is recommended that females get the same vaccine brand for all three doses, whenever possible.
    • Boys and men: One available vaccine (Gardasil) protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age.
    • The HPV vaccine (Gardasil) works by preventing four common HPV types, two that cause genital warts and two that cause some cancers. It protects against new HPV infections; it does not cure existing HPV infections or disease (like genital warts). It is most effective when given before first sexual contact (i.e., before he may be exposed to HPV).
    • The HPV vaccine is very safe and effective, with no serious side effects. The most common side effect is soreness in the arm.
  • 20. STD - CHLAMYDIA
    • In 2008, 1,210,523 chlamydial infections were reported to CDC
      • This number doesn’t include those treated for symptoms or risk without testing, estimated to be more than an additional 2 million annually between the ages of 14-39
    • Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility.
  • 21. STD - CHLAMYDIA
    • Chlamydia is known as a "silent" disease because the majority of infected people have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
    • Untreated it can spread. In woman it spreads to the uterus or fallopian tubes and causes Pelvic Inflammatory Disease (PID). In Men it can spread to the bladder, kidneys, prostate and testicles
  • 22. STD - GONORRHEA
    • CDC estimates that more than 700,000 persons in the U.S. get new gonorrheal infections each year.
      • Only about half of these infections are reported to CDC.
      • This doesn’t represent the number treated with no testing
    • Some men may have no symptoms at all. Others have signs or symptoms that appear two to five days after infection
      • Symptoms can take as long as 30 days to appear.
      • Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.
  • 23. STD - GONORRHEA
    • Women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms.
      • Symptoms can be so non-specific as to be mistaken for a bladder or vaginal infection.
      • The initial symptoms and signs in women include a painful or burning sensation when urinating, increased white, yellow clear or green, or vaginal bleeding between periods.
      • Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.
  • 24. STD - GONORRHEA
    • Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms.
    • Infections in the throat may cause a sore throat, but usually causes no symptoms.
    • Similar symptoms can be found in Trichomoniasis (another STD)
  • 25. STD – GC AND CHLAMYDIA - TESTING
    • Obtain a sample (swab) for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis.
    • Gonorrhea that is present in the cervix or urethra can be diagnosed by testing a urine sample (if you haven’t voided in the past 2 hours).
    • A quick laboratory test for gonorrhea that can be done in some clinics or doctor’s offices is a Gram stain. A Gram stain of a sample from a urethra or a cervix allows the doctor to see the gonorrhea bacterium under a microscope. This test works better for men than for women.
  • 26. STD - SYPHILIS
    • Often called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
    • Many people infected with syphilis do not have any symptoms for years, thus transmission may occur from persons who are unaware of their infection.
    • The time between infection with syphilis and the start (primary) of the first symptom can range from 10 to 90 days (average 21 days). The sores (called a chancre) last 3-6 weeks then clear (as if gone but it’s not). Later stages have more complex lesions and symptoms
    • Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
    • Blood is the most accurate testing method
    • Treatment in the early stage is easy with antibiotics
  • 27. EPIDIDYMITIS
    • Epididymitis is an inflammation of epididymis
    • Symptoms:
      • A tender, swollen, red or warm scrotum
      • Testicle pain and tenderness, usually on one side — the pain may get worse when you have a bowel movement
      • Painful urination or an urgent or frequent need to urinate
      • Painful intercourse or ejaculation
      • Chills and a fever
      • A lump on the testicle
      • Enlarged lymph nodes in the groin (inguinal nodes)
      • Pain or discomfort in the lower abdomen or pelvic area
      • Discharge from the penis
      • Blood in the semen
      • In some cases, the testicle also may become inflamed — a condition called epididymo-orchitis
    • Males of any age can get epididymitis, but it's most common in men between the ages of 20 and 39.
    • Epididymitis is most often caused by a bacterial infection or STD, such as gonorrhea or chlamydia.
  • 28. HIV AND AIDS
    • Currently available drugs do not cure HIV infection but they do prevent the development of AIDS.
    • They can stop the virus being made in the body and this stops the virus from damaging the immune system.
    • CD4 (T Cell) Count and “viral load” are key indicators to determine with your patient population
      • CD4 cells help to organize your body's defenses against disease. Doctors can take a sample of your blood and count the number of CD4 cells. Healthy adults and teenagers usually have a CD4 count of at least 800 cells per CUBIC MILLIMETER of blood (a cubic millimeter is a very small amount, roughly one small drop).
  • 29. HIV AND AIDS – CD$ AND VIRAL LOAD
    • CD4 cells help to organize defenses against disease.
    • Healthy adults and teenagers usually have a CD4 count of at least 800 cells per cubic CM
    • A lower CD4 count, leave you at higher risk of serious disease. A CD4 count below 200 means the risk of illness becomes severe.
    • Viral load tests, tell how much “virus is in the blood, are is a very important clue to how quickly HIV is doing harm.
      • It also tells how high a risk they are to transmit the disease
  • 30. CANDIDIASIS (YEAST INFECTION)
    • Can happen in men and women
    • Caused by a group of microscopic fungi or yeast. There are more than 20 species
    • Also known as:
      • Tinea Cruris (Ringworm or jock itch)
      • Thursh
    • Candidal infections commonly occur in warm moist body areas, such as underarms. Usually your skin effectively blocks yeast, but any breakdown or cuts in the skin may allow this organism to penetrate.
    • “ Opportunistic” infection secondary to antibiotic treatment
  • 31. CANDIDIASIS (YEAST INFECTION)
    • Typical areas of infection are:
      • Babies; mouth and diaper areas.
      • Adults; Genital, under arms, testicles and breasts, oral (more common with increased age).
      • Adults also can have yeast infections around dentures, under the breast and lower abdomen, nailbeds, and beneath other skin folds. Most of these candidal infections are superficial and clear up easily with treatment.
    • Rarely, the yeast infection may spread throughout the body. In systemic candidal disease, up to 75% of people may die.
    • Even common mouth and vaginal yeast infections can cause critical illness and can be more resistant to normal treatment.
  • 32. CANDIDIASIS (YEAST INFECTION)
    • Treatment includes
      • Clean/Dry
      • Probiotics (improve flora)
      • OTC Drugs (e.g. Monostat, Lotrimin, Lamisil)
      • Rx drugs (e.g. Diflucan - systemic solution)
        • For Thrush: Nystatin
      • Clotrimazole for Diaper rash and other skin areas)
  • 33. PEDICULOSIS (LICE)
  • 34. PEDICULOSIS PUBIS (PUBIC LICE)
    • aka “Crabs”
    • Not to be confused with Scabies
    • Itchiness in pubic areas and armpits is the most common complaint although not always a complaint. Pale blue spots at the follicular orifices may appear in the case of a prolonged infestation.
    • About 1/3 of people with pubic lice will have a second venereal disease and they should be screened.
    • Treatment is a wash or cream (various types)
  • 35. HERPES SIMPLEX
    • Herpes Simplex Virus (HSV) causes blisters and sores around the mouth, nose, genitals, and buttocks, but they may occur almost anywhere on the skin
    • HSV infections can be very annoying because they may reappear periodically.
    • The sores may be painful and unsightly.
  • 36. HERPES SIMPLEX
    • For chronically ill people and newborn babies, the viral infection can be serious, but rarely fatal.
    • There are two types of HSV - Type 1 and Type 2.
      • Most people get Type 2 infections, which cause genital sores, following sexual contact with an infected person. The virus affects anywhere between five and twenty million people, up to 20% of all sexually active adults in the United States.
    • The lesions of both types of herpes simplex, can be spread by touching an unaffected part of the body immediately after touching a herpes lesion
    • Oral anti-viral medications such as acyclovir, famciclovir, or valacyclovir have been developed to effectively treat herpes infections. These medications can be used to treat an outbreak or can be used constantly to suppress herpes recurrences, reduce outbreaks, and spreading by viral shedding.
  • 37. HERPES SIMPLEX
    • Between 200,000 and 500,000 people "catch" genital herpes each year. The number of Type 1 infections is many times higher. There is no vaccine that prevents this contagious disease, but other methods of prevention before and during an outbreak are important.
    • If tingling, burning, itching, or tenderness occurs in an area of the body where there is a herpes infection, the area should be kept away from other people. With mouth herpes, one should avoid kissing, sharing cups, or lip balms. For persons with genital herpes, this means avoiding sexual relations, including oral/genital contact during the period of symptoms or active lesions. Condoms can help prevent transmission of genital herpes between sexual partners and should always be used. However, they will not protect against the virus that may be living on nearby genital skin that is not covered by the condom.
  • 38. HERPES SIMPLEX
    • Patients have been aware for many years that if they kissed someone while having a fever blister, or had sex with their partner with an outbreak of genital herpes, they were likely to transmit the virus. However, most herpes is transmitted in the absence of lesions! It is now estimated that over 80% of all genital herpes is transmitted when there are no lesions and no symptoms. This phenomenon is known as asymptomatic viral shedding. People who never recall having had an outbreak of genital herpes can have positive blood tests for antibodies to herpes and can shed the virus. Taking antiviral medications daily reduces both viral shedding and disease transmission.
  • 39. HOW TO APPROACH THE CONVERSATION
    • Might be the harder kind of conversation
    • Be gender natural
      • Don’t be the guy talking to the girl, be the HC Professional
      • Try to avoid gender remarks (when boys…)
    • Establish professional rapport
    • Don’t Judge
      • Vocal or visual
    • Watch Syntax
      • Don’t:
        • Why would you…
        • It’s only…
        • Couldn’t you have…
  • 40. SPECIFIC QUESTIONS – INTERVIEW THEN EXAMINE..
    • General
      • Sexually active, Changes in sex drive, action and relation related questions
      • “ safe sex” (then define)
      • Prior surgeries
    • Illness or infection
      • Prior infections, BPH
    • Symptoms
      • Trouble voiding (start or stop), discharge (color, smell)
    • Pain
      • Painful erection, painful urination, discharge without pain
  • 41. SPECIFIC QUESTIONS – INTERVIEW THEN EXAMINE..
    • Behaviors
      • Sexual action (not acts), preferences (related to action, not acts), tools & toys
    • Infants and children
      • Legal/Illegal actions, “Experimentation”
      • Be a trusted source
    • Older adult
      • “ They still got it” – meds may have impact
    • Environment and Culture
      • Home “Remedies”, enhancement devices and drugs (pumps, poppers, etc)
  • 42. MALE ASSESSMENT
  • 43. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Inspection of the pubic hair
  • 44. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Inspection and palpation of the penis
      • Inclusion of inspection of the penis
    • Looking for cancer, infection, trauma, etc
  • 45. ASSESSING THE POSITION OF THE URINARY MEATUS
  • 46. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Inspection of the scrotum for cancer, infection, trauma
  • 47. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Palpation of the penis
  • 48. SCROTUM AND TESTICLE EXAM (SIMILAR TO A SELF EXAM)
    • Visualize and palpate the scrotum
    • Examine each testicle. Using both hands, place the index and middle fingers under the testicle with the thumbs placed on top.
    • Roll the testicle gently between the thumbs and fingers – there should be no pain.
      • Don't be alarmed if one testicle seems slightly larger than the other, that's normal.
    • Find the epididymis, the soft, tubelike structure behind the testicle that collects and carries sperm. Lumps on or attached to the epididymis are not cancerous.
    • Cancerous lumps usually are found on the sides of the testicle but can also show up on the front.
  • 49. FIGURE 21.12 PALPATING THE SPERMATIC CORD.
  • 50. ABNORMALITIES OF THE SCROTUM
    • Torsion of the spermatic cord
  • 51. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
      • Inspection and palpation of the inguinal area
  • 52. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Inspection of the perianal area
    • Palpation of the sacrococcygeal and perianal areas
    • Inspection of the anus
  • 53. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Palpation of the bulbourethral and prostate glands
  • 54. FIGURE 21.16 PLACING THE FINGER AGAINST THE ANAL OPENING.
  • 55. FIGURE 21.17 INSERTING THE FINGER INTO THE ANUS.
  • 56. FIGURE 21.18 PALPATING THE BULBOURETHRAL GLAND.
  • 57. FIGURE 21.19 PALPATING THE PROSTATE GLAND.
  • 58. AREAS OF THE MALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Stool testing for occult blood
  • 59. ABNORMALITIES OF THE PERIANAL AREA (MALE OR FEMALE)
    • Prolapse of the Rectum
  • 60. ABNORMALITIES OF THE PERIANAL AREA (MALE OR FEMALE)
    • Perianal Perirectal Abscess
  • 61. FEMALE ASSESSMENT
  • 62. AREAS OF THE FEMALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Inspection of the pubic hair
  • 63. AREAS OF THE FEMALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Inspection of the labia majora
    • Inspection of the labia minora
    • Inspection of the clitoris Inspection of the urethral orifice
    • Inspection of the vaginal opening, perineum, and anal area
    • Palpation of the vaginal walls
  • 64. AREAS OF THE FEMALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Palpation of the urethra and Skene ’ s glands
    • Palpation of the Bartholin ’ s glands
  • 65. AREAS OF THE FEMALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Inspection with a speculum to include the cervix
  • 66. AREAS OF THE FEMALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Palpation of the vaginal fornices
    • Palpation of the uterus
  • 67. AREAS OF THE FEMALE REPRODUCTIVE SYSTEM ASSESSMENT
    • Palpation of the ovaries
  • 68. AREAS OF THE FEMALE REPRODUCTIVE SYSTEM ASSESSMENT
      • Rectovaginal exam
  • 69. INTERNAL REPRODUCTIVE ASSESSMENT
    • Ovarian Myomas
      • Cancer
      • Fibroids
      • Cysts
  • 70. INTERNAL REPRODUCTIVE ASSESSMENT
    • Atrophic vaginitis
  • 71. UTERINE PROLAPSE
    • Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then descends into the vaginal canal.
    • Symptoms:
      • Sensation of heaviness or pulling in pelvis
      • Tissue protruding from vagina
      • Urinary difficulties, such as urine leakage or urine retention
      • Trouble having a bowel movement
      • Low back pain
      • Feeling as if sitting on a small ball or as if something is falling out vagina
      • Sexual concerns, such as sensing looseness in the tone of vaginal tissue
      • Symptoms that are less bothersome in the morning and worsen as the day goes on
  • 72. ECTOPIC PREGNANCY
    • Occurs when a pregnancy starts outside the uterus.
    • The most common site for an ectopic pregnancy is the fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, stomach area, or even cervix.
    • An ectopic pregnancy is often caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus.
    • This may be caused by
      • A physical block
      • Scarring
      • Past infection of the fallopian tubes (e.g. PID)
      • Hormonal factors
      • Smoking
      • Birth defects of the fallopian tubes
      • Complications of a ruptured appendix
      • Endometriosis
      • Age over 35
      • Having had many sexual partners
      • In vitro fertilization
  • 73. VAGINAL BLEEDING
    • Atypical bleeding is a symptom of many other medical conditions.
    • Assessment should include (to determine volume):
      • Comparison to “normal”
      • Number of pads
      • Size of pad
      • Pad saturation
      • Pain (or no pain)