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External Female Genitalia.330.No Pix.Gsu

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  • 1. External Female Genitalia Nursing 330 Governors State University Shirley Comer
  • 2. Relevant History
    • Menstrual History Obstetrical History
      • LMP Gravida
      • Age of menarche Para
      • Cycle characteristics abortions
    • Self care practices sexual activity
    • Urinary symptoms Vaginal discharge
    • Contraceptive use STD history
  • 3. Inspection
    • Skin color
      • pink and smooth
    • Hair distribution
      • inverted triangle by age 13
    • Labia Majora
      • symmetrical and plump
    • No lesions
      • may be sebaceous cysts
        • small yellow firm nontender
  • 4. Inspection cont
    • Inspect Clitoris
    • Labia minora
      • dark pink and symmetrical
    • Urethral opening
    • Vaginal opening (introitus)
    • Perineum
      • Episiotomy scar
    • Anus
      • increased pigmentation
  • 5. Palpation
    • Glands
      • Skene’s glands- milk urethra through vagina
      • Bartolin’s glands- palpated in labia majora through vagina
      • Assess
        • Tenderness
        • Induration
        • Discharge
        • pain
  • 6. Assess Support of Pelvis Musculature
    • Palpate perineum
      • Nulliparous-thick and smooth
      • Parous-thin and rigid
    • Ask pt to bear down
      • Should be no bulging or straining or urinary incontinence
  • 7. Practice Exam Question
    • You are assessing your 12 year old female client upon admission to the pediatric unit. While helping her undress you notice a small amount of bloody discharge on her underwear. While questioning her and her mother about her health history, she denies the onset on menarche. What should you do next?
    • A. Ask the mother to step out for a moment and ask the patient about the bloody discharge you observed.
    • B. Tell the patient and her mother that you saw the the blood on her underwear
    • C. Perform an internal speculum exam
    • D. Assume you were mistaken
  • 8. Rationale
    • A is the correct answer. A 12 year old girl may not admit to sexual activity or abuse in front of her parents.
    • B is incorrect as the mother may inhibit the pt or prevent her from reporting
    • C. is incorrect as you shouldn’t perform an internal exam but report your finding to the primary HCP
    • D. Trust yourself, you saw what you saw.